School-To-College Mentor Application 2010

Please check all the School-To-College (STC) programs that may interest you:

___ Sophomore Component___ Junior Component___ Senior Component___ Tutoring__ E-Mentor

Have you previously participated in one of our outreach programs? Yes / No If yes, please specify which program: ______

Personal Information

Name: ______Date: ______

Address: ______City: ______State: ______Zip: ______

Gender: ___ Female ___ MaleBirth Date: ______/______/______

Home Phone: ______Work phone: ______

Cell Phone: ______E-mail address: ______

Undergraduate and/or GraduateUniversity Attended: ______

Major(s)/Minor(s): ______Current Occupation: ______

1st in the family to attend college? Yes / NoEthnic Background (optional): ______

Do you speak any language(s) other than English? Yes / No If yes, please list: ______

Other Information

Will participating in STC Programs conflict with your job, classes or other responsibilities? Yes / No (If yes, please explain below)

Can you commit to meet with a student(s) at least twice? ______

Were you referred? ___Yes ___ No If yes, by whom? ______

How did you find out about STC programs?

____ BASF ____ Flyer ____ Friend ____ Presentation ____ Website _____Other (specify): ______

Mentor Questions

Please briefly answer the following questions on a separate sheet of paper:

  1. Do you have any volunteer or mentor experience? Describe your experience(s) or any programs you have participated in.
  1. "At risk" youth are in need of much support and reliability in their schedules - how do you feel that you are prepared to make this kind of a commitment to a student?
  1. What element of your background (hobbies, interests or special skills) would make you a unique mentor?
  1. If you were speaking to a culturally, economically diverse group of students about the benefits of higher education and social justice, what would you consider as important factors to convey your message effectively?
  1. Why are you interested in this program?

Volunteer Acknowledgement

I acknowledge that I am applying to be an unpaid volunteer for The Bar Association of San Francisco’s (“BASF”) School-To-College. As a volunteer, I acknowledge that I am not an employee of BASF; therefore, I am not entitled to nor will I receive any benefit normally provided to BASF’s employees such as, but not limited to, vacation payment, retirement, health care or sick pay. Further, BASF is under no obligation to offer me regular employment, and I may terminate my volunteer services to BASF at any time, with or without notice.

______

Volunteer’s SignatureDate

Please return this form via mail, fax or email to

School-To-College Program, The Bar Association of San Francisco, 301 Battery Street, 3rd Floor, San Francisco, CA94112

Email: Fax: 415-477-2388

For questions or comments about School-To-College, please contact:Bandon Butler, Program Coordinator at 415-782-9000 x8762

Thank you for applying!