Youth ENVISION Program – Mentor Job Description

Name: Jr. Youth Event | New Year Goals | January 23, 2025
Start: 2025-01-23T18:00:00-05:00
End: 2025-01-23T20:00:00-05:00
Location: Mission Empower

PURPOSE:

To give a young person (8th-12th grader) in need of social, developmental and emotional support the companionship of a caring adult.

Mentor Duties/Responsibilities:

• Responsible for planning bi-weekly meetings with the assigned mentee for at least 4 hours per month for one year
• Act as a resource and guide
• Help set goals and work toward accomplishing them
• Work closely with agency staff through phone contact, email, and personal conferences
• Submit a bi-weekly activity log
• Serve as an example/role model
• Attend initial mentor orientation/ training and initial relationship building event
• Accept and relate to youth who may not share the volunteer’s lifestyle and values
• Respect the mentee’s right to self-determination and independence

Mentor Requirements/Qualifications:

• Willing spirit
• Openness to cultural differences
• Good listening skills
• Patience
• Sense of humor
• Commitment

Matching Process:

Matches will be made on the basis of interests, skills, background, knowledge and temperament of both the young person and the mentor.

Benefits for Mentors:

• Training in communication skills, the role of a mentor, diversity training and youth development.
• Increased skills in working with youth
• Insight into the life of a youth and youth culture
• The privilege of interacting with a young person open to being guided by a caring adult

PLEASE NOTE: Due to COVID-19, Mission Empower will be following PA Dept. of Health physical distancing guidelines and youth agree to cooperate with these guidelines.

Youth ENVISION - Mentor Application

Step 1 of 6

Name*
First Last

Home Phone*
Cell Phone*
Email*
Enter Email Confirm Email

Employer*

Position*

Years Employed There*

Work Phone*
Place of Birth*

Gender*

Male

Female

Choose not to disclose
Ethnicity*
White
Hispanic
African American
Asian
Other
Choose not to disclose

Application Questions
Please answer all of the following questions as completely as possible. If more space is needed, use an extra sheet of paper or write on the back of this page.
1. Why do you want to become a mentor?*
2. Do you have any previous experience volunteering or working with youth? If so, please specify.*
3. Do you, a friend, or a family member have personal experience with a physical disability or learning difference? Please share your experience.*
4. What qualities, skills, or other attributes do you feel you have that would benefit a youth? Please explain.*
5. Can you commit to participate in the Youth Envision mentoring program for a minimum of one year from the time you are matched with a youth?*

Yes

No
6. Are you available to meet with a child eight hours per month and have contact at least once per week? Please explain any particular scheduling issues.*

Yes

No
7. Are you willing to communicate regularly and openly with program staff, provide monthly information regarding your mentoring activities, and receive feedback regarding any difficulties during your participation in the mentoring program?*

Yes

No
8. Are you willing to attend an initial mentor training session and two in-service training sessions per year after being matched?*

Yes

No

Personal References
Please list the names, addresses, and phone numbers of three people you would like to use as character references (only people you have known for at least a year). Include at least one relative and at least one professional reference. Any information Youth Envision Mentoring Program gathers from these references will be held as confidential and not released to you, the applicant.
Reference 1 Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship:*

How long known:*

Reference 2 Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship*

How long known*

Reference 3 Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship*

How long known*

Information Release
I understand it will be necessary for the Youth Envision Mentoring Program (Mission Empower) to conduct a background check regarding my driving record, criminal history, personal references, and employment. I authorize Mission Empower to obtain any needed information regarding my driving record, legal/criminal history, character references, and employment from any state or federal agency, my employer, and personal references for the purposes of participating in a mentoring program. Further, I provide permission for Mission Empower to conduct the same investigation of my background in previous states in which I have resided. Further, I understand that information about myself will be anonymously (without my name) shared with a prospective mentee(s) and his/her parent(s)/guardian(s) to aid in determining a suitable match. Once a mentor/mentee match is determined, my identity and any other information known about me may be shared with the mentee and parent/guardian to ensure and aid in facilitating a safe and successful match relationship.*
I Agree
Signature*

Date*
MM slash DD slash YYYY

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Have you been a resident of Pennsylvania for the past 10 years?*
Yes
No
Driver's License/State ID #*
State*

Please list any other cities, states, and dates of residency during the past 10 years:
Address 1
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From
MM slash DD slash YYYY

To
MM slash DD slash YYYY

Address 2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From
MM slash DD slash YYYY

To
MM slash DD slash YYYY

Address 3
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From
MM slash DD slash YYYY

To
MM slash DD slash YYYY

Mentor Interest Survey
Name
First Last

Date
MM slash DD slash YYYY

Please complete all the following. This survey will help Youth Envision Mentoring Program know more about you and your interests and help us find a good match for you.
1. What are the most convenient times for you to meet with your mentee? Please check all that apply.*
Weekdays
Lunchtime
Afterschool
Evenings
Weekends
Please list any specific days and times that work best for you:

2. Please indicate age group(s) you are interested in working with:*
Age 12-14
Age 14-18
Age 18-21
3. Do you speak any languages other than English? If so, which languages?*
4. Would you be willing to work with a child who has disabilities? If so, please specify disabilities you have personal or professional experience with.*
5. What are some favorite things you like to do with other people?*
6. What are your favorite subjects to read about?*
7. What is your job and how did you choose this field?*
8. What is one goal you have set for the future?*
9. If you could learn something new, what would it be?*
10. What person do you most admire and why?*
11. Describe your ideal Saturday.*
12. Please check all activities you are interested in:*
Biking
Hiking
Golf
Fishing
Camping
Boating
Swimming
Animals
Science
Music
Gardening
Movies
Cooking
Sports
Parks
Shopping
Reading/Library
Yoga
Art/ Photography
Board Games
List any details (i.e. types of sports, music, etc.) and/or other areas of strong interest:*

PLEASE READ CAREFULLY BEFORE SIGNING

The Youth Envision Mentoring Program appreciates your interest in becoming a youth mentor!
Please read and check each of the following check boxes:
IMPORTANT INFORMATION ABOUT CLEARANCES

Mission Empower must receive your clearances before you can begin mentoring. Volunteers who have NOT resided within Pennsylvania for the past 10 years MUST submit the following upon acceptance into the program:

1. PA Child Abuse History Clearance
2. PA State Police Request for Criminal Record Check
3. FBI Background Check and Fingerprinting

Volunteers who HAVE resided within Pennsylvania for the past 10 years MUST submit the following upon acceptance into the program:

1. PA Child Abuse History Clearance
2. PA State Police Request for Criminal Record Check
3. Disclosure Statement Application for Volunteers

For more information on how to submit your background checks, please visit the following websites:

1. PA Child Abuse History Clearance
2. PA State Police Request for Criminal Record Check
**3. *FBI Background Check and Fingerprinting**
Note: PACogentID is an approved FBI criminal history channeler. When registering for your FBI background check, please choose [23PACSA6344.2 DHS VOLUNTEER] as your reason. KEEP A COPY OF YOUR REGISTRATION RECEIPT. ALL FBI BACKGROUND CHECK COSTS WILL BE REIMBURSED BY MISSION EMPOWER UPON RECEIPT OF YOUR CERTIFICATE.
You must agree to and check the box below to be considered for this program:
I agree to follow all mentoring program guidelines and understand that any violation will result in suspension and/or termination of the mentoring relationship.
You must agree to and check the box below to be considered for this program:*
As an applicant for a Mission Empower volunteer position, I understand and acknowledge that my acceptance as a volunteer is subject to the positive and/or negative results of each of the aforementioned National and State Service criminal history elements.
You must agree to and check the box below to be considered for this program:*
I understand that Youth Envision Mentoring Program is not obligated to provide a reason for their decision in accepting or rejecting me as a mentor.
Please read and check the box below if you agree.
(OPTIONAL) I agree to allow Youth Envision Mentoring Program to use any photographic image of me taken while participating in the mentoring program. These images may be used in promotions or other related marketing materials.

I understand I must return all of the following completed items along with this application (included in online application), and that any incomplete information will result in the delay of my application being processed:*
Click if you agree
- Information Release Form
- Personal References Form
- Interest Survey Form
- State Police and FBI Criminal Background Release Forms
- Child Abuse and Neglect Release Form

By signing below, I attest to the truthfulness of all information listed on this application and agree to all the above terms and conditions.*

Date*
MM slash DD slash YYYY

CAPTCHA

Youth ENVISION Program – Mentor Job Description

PURPOSE:

To give a young person (8th-12th grader) in need of social, developmental and emotional support the companionship of a caring adult.

Mentor Duties/Responsibilities:

Mentor Requirements/Qualifications:

• Willing spirit
• Openness to cultural differences
• Good listening skills
• Patience
• Sense of humor
• Commitment

Matching Process:

Matches will be made on the basis of interests, skills, background, knowledge and temperament of both the young person and the mentor.

Benefits for Mentors:

• Training in communication skills, the role of a mentor, diversity training and youth development.
• Increased skills in working with youth
• Insight into the life of a youth and youth culture
• The privilege of interacting with a young person open to being guided by a caring adult

Youth ENVISION - Mentor Application

Step 1 of 6

Application Questions

Please answer all of the following questions as completely as possible. If more space is needed, use an extra sheet of paper or write on the back of this page.

Personal References

Information Release

Please list any other cities, states, and dates of residency during the past 10 years:

Mentor Interest Survey

Please complete all the following. This survey will help Youth Envision Mentoring Program know more about you and your interests and help us find a good match for you.

PLEASE READ CAREFULLY BEFORE SIGNING

IMPORTANT INFORMATION ABOUT CLEARANCES

Upcoming Events

3 Training Workshop Classes (January 7, 2025)

Youth Event | New Year Goals | January 12, 2025

Jr. Youth Event | New Year Goals | January 23, 2025

Youth ENVISION Program – Mentor Job Description

PURPOSE:

To give a young person (8th-12th grader) in need of social, developmental and emotional support the companionship of a caring adult.

Mentor Duties/Responsibilities:

Mentor Requirements/Qualifications:

• Willing spirit • Openness to cultural differences • Good listening skills • Patience • Sense of humor • Commitment

Matching Process:

Matches will be made on the basis of interests, skills, background, knowledge and temperament of both the young person and the mentor.

Benefits for Mentors:

• Training in communication skills, the role of a mentor, diversity training and youth development. • Increased skills in working with youth • Insight into the life of a youth and youth culture • The privilege of interacting with a young person open to being guided by a caring adult

Youth ENVISION - Mentor Application

Step 1 of 6

Application Questions

Please answer all of the following questions as completely as possible. If more space is needed, use an extra sheet of paper or write on the back of this page.

Personal References

Information Release

Please list any other cities, states, and dates of residency during the past 10 years:

Mentor Interest Survey

Please complete all the following. This survey will help Youth Envision Mentoring Program know more about you and your interests and help us find a good match for you.

PLEASE READ CAREFULLY BEFORE SIGNING

IMPORTANT INFORMATION ABOUT CLEARANCES

• Willing spirit
• Openness to cultural differences
• Good listening skills
• Patience
• Sense of humor
• Commitment

• Training in communication skills, the role of a mentor, diversity training and youth development.
• Increased skills in working with youth
• Insight into the life of a youth and youth culture
• The privilege of interacting with a young person open to being guided by a caring adult