N2Life_MentorApplication

N2Life Project Mentor Application
You must be at least 25 years of age to mentor. Are you at least 25 years old?
Please continue applying by completing the sections below.
- Full Name
  
  First NameLast Name
- E-mail
- Gender
- Phone Number, Preferred
  
  Area CodePhone Number
- Phone Number, Alternate
  
  Area CodePhone Number
- Present Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- My present address is the same as my permanent address.
- Permanent Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Faith I most closely identify with
  
  Other
- I belong to or participate in a faith community
- Earliest Date You Can Start
  
  MonthDayYear
- Will you commit at least one hour each week or two hours every other week to your mentee?
- If you cannot commit to the schedule above, please explain:
- Mentoring Partner. Kansas Department of Corrections requires female mentors to pair with a male mentor.
- Mentoring Partner's Name
- Name of Faith Community
- Faith Community Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Faith Community Phone Number
  
  Area CodePhone Number
- Faith Community Leader
  
  First NameLast Name
- Leader's Title
- Does your faith community have a prison ministry?
- Name of Prison Ministry
  Name of your faith community's prison ministry
- Employment Status
- Please state your current or most recent employer:
- Current or Most Recent Employer
- Employed From Date
  
  MonthDayYear
- Employed To Date
  
  MonthDayYear
- Hobbies, passions, and special skills that might help us match you with an incarcerated client:
- I have religious or ministry training.
- I have completed the required Kansas Department of Corrections Mentoring 4 Success training.
- Have you been incarcerated in the past?
- Please list recent institutions and years at each institution.
  
  Incarceration history will NOT automatically disqualify you.
- Institution Name
- From Year
- To Year
- Institution Name
- From Year
- To Year
- Institution Name
- From Year
- To Year
- Are you currently on probation or parole?
- Officer's Name
- When will supervision end?
- References
- By clicking the submit button, I certify that the facts contained in this application are true and complete to the best of my knowledge.
- Electronic Signature
  
  First NameLast Name
- Please type the words you see below.
- Newsletter
- Should be Empty:

N2Life Project Mentor Application

Please list recent institutions and years at each institution.