Mentor Application TEEN INFORMATIONFull Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Cell*Email* Date of Birth MaleFemaleSchool Attending*Grade*PARENT INFORMATIONParents Marital StatusMarriedDivorcedSeparatedSingleWidowedFather's NameFather's Email Father's Cell NumberFather's OccupationFather's Work NumberMother's NameMother's Email Mother's Cell NumberMother's OccupationMother's Work NumberREFERENCEReference's Name*Position*Email* Phone*HOBBIES Art Basketball Biking Board Games Boating Camping Cooking Eating Fishing Football Golf Hiking Movies Music Parks Reading Running Science Shopping Soccer Swimming Chesed Projects Other Activities ACADEMIC PREFERENCESPlease indicate the subjects which you feel most comfortable assisting an elementary child in.English Subjects English Social Studies Math Science History French Other Hebrew Subjects History Talmud Ivrit Toda’ah Torah Naach Other Do you have any previous experience volunteering or working with youth?*Are there any skills you are bringing to this program? (i.e. CPR, camp counselor etc.)What are your goals in becoming a mentor?*Is there anything else we should know about you that would assist us in matching you with the appropriate mentee? T-SHIRT SIZE (check one):SMALLMEDIUMLARGEX-LARGEXX-LARGEXXX-LARGEMENTORING CONTRACT - JYN CONNECT RULES, REGULATIONS & EXPECTATIONS • Please read this carefully before submitting:I am committed to being at every JYN Connect training session, meetings and follow up meetings for the duration of the JYN Connect session. I am aware that failing to be consistent and lack of commitment will be a disappointment to my mentee as well as the JYN Connect directors and will lead to my being excused from the JYN Connect program. I am aware that any problems, concerns or suggestions concerning my mentee will only be discussed with a member of the JYN Connect advisory board and will be treated as highly confidential information. Throughout the JYN Connect program I feel confident that I can supervise assist and mentor the child that is assigned to me. I realize that although there are always adults on hand, the child placed in my care is my responsibility. JYN Connect participants are expected to maintain proper decorum and attitude during the entire program. Disruptive behaviour (including, among other things, sexual or other inappropriate innuendo) will not be tolerated in any way shape or form. Each participant is expected to conduct him/herself appropriately as a Jew (including through the observance of Kashrut, wearing a Kipa), in accordance with applicable standards of JYN - Jewish Youth Network. JYN Connect appreciates your interest in becoming a mentor to a child. By submitting below, you attest to the truthfulness of all information listed on this application. That you have read and understood the program’s rules, regulations, and responsibilities for becoming a mentor. If selected I will follow the rules of the program and be a dedicated mentor.