VOLUNTEER/MENTOR APPLICATION

***Please provide as much information as possible. This information is used to screen potential Volunteers and Mentors. Missing information could delay the processing of this form.***
APPLICANT INFORMATION:
Begin: - Current
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Vehicle Information:
EMPLOYMENT:
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Help for APT/LOT:
Help for PO BOX:
Help for Post Direction:

EMERGENCY CONTACTS

EMERGENCY CONTACT:
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REFERENCES

REFERENCES:

INTERESTS

INTERESTS:

Locations you are interested in volunteering at:

Be sure to designate one and only one as a primary Location. Add any additional locations that you would be willing to volunteer at.
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Positions you are interested in:

AVAILABLITY

AVAILABILITY:

ORGANIZATION AFFILIATIONS

ORGANIZATIONAL AFFILIATION:

There are several organizations that Mentor offenders. If you are a member of any of these organizations or in any way affiliated with one or more, please indicate here.

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HISTORY

HISTORY:

Information in this section is necessary for entry into a Kansas Department of Corrections facility. Answering 'yes' to any of these questions will not necessarily eliminate an applicant from being approved to Mentor.

GENERAL INFORMATION

GENERAL INFORMATION:
Please add degrees, licenses or certifications in any field you have received: