Thank you for your interest in becoming a mentor with Catalyst Family Services. Our mentoring program connects caring adults with individuals who need guidance, encouragement, and consistent support. This application helps us learn about your background, interests, and availability so we can make the best possible mentor–mentee match. All information is confidential. A team member will contact you with next steps, including training and required background checks. Thank you for your commitment to strengthening families and empowering youth!

Personal Information

First name

Last name

Email

Phone

Birthday

Month

Day

Year

Gender

Female

Male

Multi-line address

Country/Region

Address

City

Zip / Postal code

Position

Mentor

Therapist

Counselor

Preferred Method of Contact

Email

Text

Call

Education and Employment

Current Occupation

Employer Name

Employer dPhone

Mentorship Interest

What strengths or personal qualities do you believe you bring to mentorship?

Describe any previous mentoring, youth work, tutoring, coaching, or leadership experience.

What age group of youth are you most interested in working with?

6-10

11-13

14-18

Are you comfortable mentoring a youth from a different cultural or socioeconomic background?

Yes

No

Availiability

How many hours per month can you commit to mentoring?

Can you commit to a minimum of 12 months in the program?

Yes

No

Background and Safety

Do you consent to a background check?

Yes

No

Do you have reliable transportation?

Yes

No

Have you ever been convicted of a crime? If yes, please explain.

Are there any mental or physical conditions that may affect your ability to mentor? If yes, please describe.

Skills, Interests and Personality

Hobbies and Interests

Languages Spoken

Special Skills (music, technology, sports, arts, etc.)

References

Reference #1 (Full Name, Relationship, Phone, Email)

Reference #2 (Full Name, Relationship, Phone, Email)

Reference #3 (Full Name, Relationship, Phone, Email)

Confirmation

Applicant Signature

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Print Name

I certify that all information in this application is true and complete to the best of my knowledge.

Yes

No

Date Completed