Adobe FormsCentral Logo
  • Image-1
  • In 5 simple steps, you can make a difference in our community by reading to an at-risk elementary student in the Reno & Sparks area. 

    Mentor Requirements
     

    • Must be 18 or older 
    • Ability to work with culturally diverse individuals
    • Ability to work with at-risk youth 
    • Ability to commit to 1 academic year with your mentee 

    *Financial hardships payment assistance for fingerprinting fees through WCSD 

     


     Please complete the application in its entirety. Some of the questions are personal, but necessary to establish your eligibility to serve as a mentor.
    Information contained in this application is confidential and will not be shared with a third party. All personal data on volunteers are stored in a central location under lock and key.

    *There is no option to SAVE your answers and return later. Once you start, you must complete it.

     

     
  •  / /
  •  / /
  • Education/Experience:
  • Employment:
  • Mentoring Information:
  • Please indicate the day(s) that you may be available to mentor during the following set out times. (Mentoring sessions are in .45min to 1hr increments before/after school.)
     
  • Please prioritize the following criteria you would prefer in a mentee(s).
     
  • Background Check:
     
  • List names and daytime phone numbers of three references.
     
  • I certify that all the information submitted by me on the application is true and complete to the best of my knowledge, and I understand that any false information, omissions, or misrepresentation of facts called for on this application may be cause for denial of my application or, if I am already a 360 Blueprint volunteer, discharge at any time. By my signature and of my free will, I do hereby agree to indemnify and not hold culpable 360 Blueprint and its agents for any and all claims or demands, costs or expenses arising out of any injuries, damages or other losses, whether personal or property sustained by me during any 360 Blueprint activity. By signing this document, I agree to have the above references contacted. Please note that the above information will be held in your personal file and on the jobsite in case of an emergency. 
  •  / /
  • Volunteer Consent to Background Check
  •  / /
  •  / /
  •  / /
  • In consideration of the receipt and evaluation of this application by 360 Blueprint, I agree and represent that: The information contained in this application is correct to the best of my knowledge. I authorize references or any other person or organization, whether identified or not identified in this packet to give you any information (including opinions) regarding my character and fitness for the job description. i hereby release any individual, 360 Blueprint staff or church official, reference, or any other person or organization, whether or not identified in this packet, of any and all liability for damages of whatever kind or nature which may result through the process of the background investigation. I FURTHER STATE THAT I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOFA ND SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding release, which I have read and understand. I understand that I may consult with an attorney before signing this document. A facsimile or photocopy of this authorization shall be as valid as the original. I further understand that a criminal record check may be conducted on me and I consent to any such check, as long as I remain a volunteer or staffed with 360. The above-mentioned may be repeated at any time.
  •  / /
  • Mentor Interest Survey Please complete all of the following. This survey will help 360 Blueprint to know more about you and your interests and help us find a good match for you.
  • Please check all activities in which you are interested:
  •  / /
  • Should be Empty: