Mentor Application - LUK Mentoring

Become a Mentor

"*" indicates required fields

LUK Mentoring Application

Full Name*

Address*

Street Address City State ZIP Code

Email*

Phone*

Date of Birth*

Students

College/School Currently Attending

Grade Level

School Address

College Mailing Address (If Applicable)

Volunteer Activites

Please list any current or past volunteer experiences:

Please read carefully before signing:

By signing below I attest to the truthfulness of all information on this application. I agree to allow the LUK Mentoring Program to confirm information listed. I understand the LUK Mentoring program is not obligated to match me with a youth and if selected, agree to follow the guidelines listed below.

I agree to:

A one-one-one interview with LUK Mentoring Staff
A background check (CORI & References) (Provide Goverment-issued ID)
Provide proof of license and car insurance (Community Based)
Participate in LUK Mentor training
Meet youth according to program guidelines
Commit to mentoring according to program guidelines
Participate in supervision with LUK Mentoring Staff
Keep LUK Mentoring staff informed of progress and/or concerns in the mentoring relationship
Participate in LUK Mentoring program match evaluations

Applicant Digital Signature*

Name

This field is for validation purposes and should be left unchanged.