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| Application for Mentors |
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Growing Green Hands, Inc, (Not for profit) Mentoring Application
Program Information: Youth mentoring programs have had a profound effect on the quality of life for disadvantaged, single-parent or otherwise ‘at-risk’ identified children all over the country and around the world. Nationally, the well-known mentoring program, Big Brothers/Big Sisters, found that mentored children were significantly less likely than their peers to use illegal drugs or alcohol, skip school or be welfare dependant as adults. In addition, these children were significantly more likely to graduate from high school and from a college or university. One survey of caseload files of children in mentoring relationships found: 77% improved school grades; 63 % improved school behavior; 93% stayed free of drugs or alcohol or both; 56% reported improved relationships with families; 86% experienced increased exposure to cultural and educational services; 69% had improved peer relationships; and 96% stayed out of gangs! These are impressive results! Clearly, mentoring makes a difference! The Growing Green Hands Mentoring Program seeks to expand the quality of life benefits of mentoring beyond the obvious positive outcomes for the mentored youth, to include benefits for the mentor, the community and our planet. This will be accomplished in several ways. 1. One-on-one mentoring (based on a principle of reciprocity) 2. Group mentoring (to promote interpersonal intelligence and to increase collective consciousness) 3. Experiential and Service learning (to promote community involvement, civic responsibility, and increase vocational skills/opportunities) 4. Developmental asset building (to increase intrapersonal intelligence) 5. Green education: Integrated ecology and natural systems thinking (to increase naturalist intelligence and promote healthier living for local and global sustainability) It must be clear to all who participate in this program that we intend to be guided by the principle of RECIPROCITY in our mentor-mentee relationships, our community relationships, and in our relationship to the earth. The Oxford English Dictionary defines Reciprocity - a state or relationship in which there is mutual action, influence, giving and taking, correspondence, etc., between two parties. By teaching youth and modeling reciprocal relationships, we reduce the likelihood of creating entitlement and encourage respect for self and others. Additionally, by offering all participants “Green” education that will come in a variety of modalities, we will grow our awareness of environmental issues and increase our potential for balanced healthy living and for building sustainability. This program will further support the mentor and mentee relationship with nature-connecting activities (based on EcoPsychology) to be experienced individually and in groups. These activities are offered in place of other possible activities (e.g. going to movies or going out to eat in restaurants), that do not necessarily build reciprocity in mentoring relationships. The unique approach of this program will also foster the sense of kinship and history by linking kids with older adults. Many of these youth will come from fragmented families who don’t have grandparents either nearby or in their lives at all; and the historical events that come alive through listening to the personal stories shared by older adults is such an invaluable gift for both generations.
Minimum Mentor Requirements: • Desire to make a profound difference in the life of a young person for one year. • Minimum age 50 years (or close). • Willingness to give 6-8 hours a month to include: 1) 1hour a week with one’s mentee; 2) 2 hours of organized group mentoring meetings/gatherings with your mentee each month; 3) 2 hours of mentor training/support meetings (will be offered as group and/or as individual meetings) approximately every 8 weeks or per your request as needed. • The ability to pass a criminal/child welfare, background check. • Successful completion of initial interview, reference check and 10 hours preliminary training sessions. (Please Print): Legal Name: ________________________________________________________________________ Name you prefer to be called: ________________________________________________ Mailing Address: __________________________________________________________ Home Address: ____________________________________________________________ If applicable, where do you work: _____________________________________________ Work Address: ____________________________________________________________ Daytime Phone: Evening Phone: Email:
Please answer in essay form (no less than 300 words) and attach to application: 1) Why do you want to be a mentor? 2) What do you hope to gain personally from mentoring? 3) What do you hope to offer as a mentor? 4) What are your relationships with family and friends like now? 5) In what ways are you currently supporting “green” living and environmental consciousness? 6) What concerns do you have about mentoring or your participation in the program?
Demographic information: (To be used if applicable for mentor/mentee match.) This section is completely voluntary. You do not need to provide this information if you don’t wish to. If you choose to fill it out, please use the terminology that is most comfortable for you. One of our goals in creating this mentoring program is to ensure that mentees are able to bring all of their ‘social identities’ to the mentoring relationship. Some youth may wish to have a mentor with similar racial, ethnic, language, orientation and gender background.
Race/Ethnicity/Culture: ____________________________________
Languages in which you are fluent: ____________________________________
Gender Identity and Sexual Orientation: ____________________________________
Religious or Spiritual Affiliation: ____________________________________
Hobbies and Outdoor Interests: ____________________________________
Any Other Demographic information: ____________________________________
Personal References: Please include name, address and phone number 1) 2) 3)
Please describe and list specific ways in which you would be willing to allow Growing Green Hands Mentees (youth 8-17) and other community volunteers to serve you. Some examples: I would enjoy mentoring and connecting with a youth while doing activities that I enjoy… - such as talking/sharing life stories, playing music, needlework-pottery-photography-wood carving or other hand crafting-walking/hiking-environmental restoration-fishing-boating or other outdoor activities; I would like help in creating/planting a healing garden and/or caring for my garden/yard/; I need help with light house/pet chores, errands, learning technologies, other…; I would be willing to apprentice/job shadow/teach a youth interested in learning about my profession/occupation etc.)
AUTHORIZATION FOR RELEASE OF INFORMATION I submit the following information to assist Growing Green Hands, Inc, and its programs in performing background checks. PLEASE PRINT CLEARLY IN INK NAME:_________________________________________________ DATE OF BIRTH: ____ / ____ / ____ PRESENT ADDRESS
How long at current address? _____ YRS _____ MOS DRIVERS LICENSE NO.: _____________________ SOCIAL SECURITY NO.: __ __ __ - __ __ - __ __ __ __ (Note State if not CA: ___________) PREVIOUS ADDRESS (For past 5 years) ADDRESS: How long at this address? _____ YRS ___ MOS ADDRESS:
How long at this address? _____ YRS ___ MOS OTHER NAMES I HAVE USED: (List Last Name, First Name, Middle Name)
NAME(S) OF SPOUSE(S) and/or SIGNIFICANT PARTNERS: (List Last Name, First Name, Middle Name of current and former spouses/partners)
NAME(S) OF CHILD(REN): (List Last Name, First Name, sex, and date of birth for each child presently or previously in your household
USE OF PHOTOGRAPHS AND VIDEOS Some of the Growing Green Hands (GGH) events, such as the monthly group mentoring meetings or service learning projects will be photographed and/or videotaped. If you choose to attend any of these events, you may be photographed and/or videotaped. Please check below if you do not give GGH and GGH project partners permission to copyright, broadcast, duplicate, exhibit and/or use film, audiotape, photographs, printed information, and/or drawings of yourself without limitation for general education, information dissemination, and research purposes in videos, audiotapes, and printed publications, and on the World Wide Web. In addition, you waive any right to inspect or approve the finished publication or other product in which your image/information might be used. Check here if you do not give permission to be included in pictures or videos. I have read and agree to the expectations listed for GGH mentors, publication guidelines, and the Use of Photographs and Videotape guidelines as indicated above. I agree to report to any past convictions. I authorize GGH to contact my references and process a background check. I will inform GGH of any convictions or charges that relate to minors or vulnerable adults. ______________________________________________________________________________________ Print Signature Date Please return this completed application GGH in person, by mail or fax to: If you have any questions regarding the program or this application, please contact Tamberly Mott @415 632-8702 or Donna Wolfe @ 467-3200. We also invite you to check out www.growinggreenhands.org |
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