Destined For Greatness – Fighting to Be Heard Mentor Program

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Name

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MENTOR APPLICATION FORM

All Fields Required.

Personal Information

Name*

First Last

Email Address*

Gender*

Male

Female

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Mobile Phone*

Work Phone

Employer*

Occupation

Employer's Address

Street Address Address Line 2 City State ZIP Code

References

Please list four references: (please include at least one family member, one personal friend and one work reference)

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Relationship*

Phone*

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Relationship*

Phone*

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Relationship*

Phone*

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Relationship*

Phone*

In making this application to be a volunteer, I understand that the Fighting To Be Heard Youth Mentor Program routinely performs criminal and driving record checks of all volunteers for the position of mentor for which I am applying. All mentors must undergo the Federal Background Check.
Prospective mentors are responsible for procuring the Federal Background Check and submitting the results to DFGOYC. When selecting your method of payment, DFGOYC requests that you select option two ($55.00) which is delivered via email and mail. For verification purposes and the organization’s volunteer records, DFGOYC also requests that the mailed COPY sent to your home stays SEALED and UNMARKED. You may forward your sealed and unmarked copy for review and acceptance to:

Mr.James Kyles
CEO/President
Destined for Greatness Outreach Youth Center
963 Welch Street SW
Atlanta GA 30330

All Records will be kept confidential. If I fail to sign, it may be grounds for rejecting me as a mentor.

I certify to the best of my ability that the information provided on this application is true and accurate. I also understand that misinformation knowingly provided here, and on subsequent mentor application forms, is grounds for dismissal.

Signature*

please enter your full legal name

Date*

today’s date

Social Security Number (needed for criminal record checks)*

Birthday*

Fighting To Be Heard Youth Mentor Program

Mentor Application Form

MENTOR APPLICATION FORM

Personal Information

Volunteer Information

References

Optional Information