Persistence Pays Off Mentor Application: Day of Caring

Name *

First

Last

Employer *

Title / Position *

Full-Time or Part-Time? *

Work Phone Number *

Cell Phone Number *

Email *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

United Way of Allen County Code of Conduct

I understand that by accepting these terms, I am agreeing to adhere to the guidelines and code of conduct provided by United Way:

• Agree to having a background check done.

• Make a one school year commitment to mentoring from September to May.

• Attend training sessions as required.

• Be on time for scheduled meetings; notify United Way if I am unable to keep my mentoring commitment.

• Engage in the relationship with an open mind.

• Accept advice and assistance from United Way.

• Keep discussions with my mentee confidential.

• Ask United Way when I need assistance, do not understand something, or am having difficulty with my mentoring relationship.

• Notify United Way of any changes in my employment, contact information, or any event that would prevent completion of mentor duties.

• Notify United Way of any significant change in my mentee.

• Refrain from contacting or seeing my mentee outside of the established parameters where the program takes place.

Conduct Agreement *

I hereby agree to serve as a United Way of Allen County mentor in the Persistence Pays Off initiative and accept responsibilities for all assignments pertaining to this position.

Applicant Signature *

Signature Confirmation *

By checking this box, you acknowledge and affirm that the digital signature provided herein is your own, considered valid, and holds the same legal validity as a handwritten signature.