Bunk 57 Ministries - P.L.S.M. Mentor Application

We appreciate your interest in becoming a mentor. The information in this application will help us to match you with a young brother and will be kept confidential.

Date Input

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Birthdate

Email

Phone Number

Marital Status

Name of Spouse (if Applicable)

Names of Children (if Applicable)

Would you agree to have us check your name through federal and state criminal records of child abuse and neglect proceedings?

Yes

No

Social Security Number (Required for Background Check)

Do you have a valid Driver's License?

Yes

No

If yes, Exp. Date & State

Do you have current vehicle insurance as required by North Carolina law?

Yes

No

Work Details

Occupation

Company

Work Phone

List any special interests, skills or hobbies you have:

List examples of any prior volunteer experience:

If you selected 'Other', please describe

Spiritual Information

What church are you currently attending?

How long have you been involved?

Please write a short testimony of your spiritual journey and present relationship with God.

What do you feel you have to offer a young brother in the area of Youth Mentorship?

What motivates you to take an interest in youth facing adverse childhood experiences?

List three people who can serve as a character reference for you. Please list at least one Christian Leader as a reference. (Pastor, Bible study leader, Sunday school teacher, etc)

If you agree to become a mentor, you will be asked to agree to the following basic requirements:

• To serve as a Mentor, you will be asked to make a minimum commitment of one year with openness to continue in the relationship on a long-term basis.

• To attend Fruit That Won’t Spoil discipleship training before you will be considered for a one-on-one match with a young brother.

• To maintain weekly contact with your young brother either in person or by phone.

• To be dedicated and dependable in trying to assist your young brother to achieve success in their spiritual, educational and emotional development.

• To base your relationship on respect for the young brother and his family.

• To maintain monthly phone contact with a mentor supervisor at Bunk 57 Ministries.

• To complete one community service project with your young brother every year.

Bunk 57 Ministries reserves the right to accept or decline volunteers based on the information gathered. For reasons of conKdentiality Bunk 57 Ministries will not share this information or reasons of denial with any applicant.

Signature

P.L.S.M. Youth Mentoring

"Change a Story, Change a Destiny"

P.L.S.M. Youth Mentor Application