Applicant information

First name

Enter a first name

Last name

Enter a last name

Phone

Enter a phone number

Phone type
Email address

Enter a valid email address

Email type

Address

Address

Enter an address

Apartment, suite, etc. (optional)
City

Enter a city

Country/region

Enter a country

State

Enter a state

ZIP code

Enter a zip

Date of birth

Month

Enter a month

Day

Enter a day

Year

Enter a year

Background

Gender

Enter a gender

Ethnicity

Enter an ethnicity

Education

Enter an education

Languages
A.

About You

Why are you hoping to mentor a small group of young people with Simpson Housing Services?

Enter a response

Briefly describe your experience working or volunteering with youth (name of organization, time of involvement, type of work):

Enter a response

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.

Enter a response

Please describe your experience working with people from a variety of cultural backgrounds.

Enter a response

What qualities, skills, training, or other attributes do you feel you have that would benefit a young person? Please explain.

Enter a response

Have you had any experience facilitating a group and managing group dynamics? Please describe if applicable.

Enter a response

Can you commit to the Simpson Youth Group Mentoring Program for 10 months (September through June), attending weekly programming, and bimonthly outings? Do you forsee any issues meeting the above requirement (ex: planned extended vacations, possible relocation, unreliable transportation, etc.)?

Enter a response

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?

Enter a response

Have you ever been refused participation in any other youth program? If yes, please explain.

Enter a response

Do you have a current driver’s license and reliable vehicle that you're willing to use while volunteering?

Enter a response

Have you ever been convicted of a crime? If yes, please explain.

Enter a response

Have you ever been investigated or convicted of child abuse or neglect, or of sexually abusing a youth 18 years or younger? If yes, please explain.

Enter a response

B.

Personal References

For each reference please include name, email, and phone number.

Reference #1 Name: First and Last

Enter a response

Reference #1: Email

Enter a response

Reference #1: Phone

Enter a response

Reference #2 Name: First and Last

Enter a response

Reference #2: Email

Enter a response

Reference #2: Phone

Enter a response

Reference #3: First and Last

Enter a response

Reference #3: Email

Enter a response

Reference #3: Phone

Enter a response

Confirmation

By proceeding, I agree to the Terms of Service and Privacy Policy.