Become a Mentor

LUK Mentoring Application

Name (First and Last)*

Home Address/Mailing Address (Line/City or Town/State/Zip Code)*

Date of Birth (Must be at least 18, MM/DD/YYYY)*

Email Address*

Phone Number*

Students

College/School currently attending

Grade Level

Address

College Mailing Address (if applicable)

Volunteer Activities

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*

Date*