Mentor Program Application
Mentoring Application

CKSD2 Mentor Program
"The POWER of TWO!"

P.O. Box 8
Silverdale, WA 98383
360-662-1726
First Name:    Last Name:
Date of Birth:       Gender: 

Street Address:  

City:   Zip: 

Ethnicity:    

Email Address:

Main number we should call to reach you:    

Secondary Phone Number: 

 

Employment

Name of employer: 
Work Phone:     May we call you at work?  Yes    No

What days of the week are you available to volunteer? (Hold down the Ctrl key to select multiple options)

 

Interest Survey

TopicsYesNoComments
Do you speak/use a language other than English proficiently?

Do you prefer to work with quiet, shy, and/or introverted students?

 
Do you prefer to work with outgoing, social, and/or extroverted student?

 
Would you be interested in working with students experiencing disabilities?

 
Would you prefer to work with a student from a particular racial/ethnic/cultural group?

 


Please indicate the school(s) you prefer.
 

Elementary Schools

Brownsville Elementary  
Clear Creek Elementary                  
Cottonwood Elementary
 Cougar Valley Elementary
 Esquire Hills Elementary
Green Mountain Elementary
Hawk Elementary at Jackson Park
PineCrest Elementary
Silver Ridge Elementary
Silverdale Elementary
Woodlands Elementary

Middle School

Central Kitsap Middle
Ridgetop Middle
Fairview Middle

High School

Olympic High School

 

 

Please indicate the types of things you enjoy doing.

Other interests: 

 Arts and crafts

Photography

 Attending the theater or plays

Playing a musical instrument

 Backpacking

Playing sports

 Board and/or card games

Reading

 Computers (e.g., programming)

Riding a bike

 Cooking

Riding a horse

 Doing boxed puzzles

Singing

 Drawing

Skiing

 Going to the zoo or museum

Training animals

 Hiking

Video/computer games

 Internet

Watching movies

 Listening to music

Watching sports

 Outdoor activities

Other 

Short Answer

1.  What qualities should a good mentor possess?

2.  What qualities do you have that make you a good friend?

 

Mentor Agreement

As a volunteer for the CKSD Mentoring Program, I agree to the following:

To complete the required community schools background check before meeting with my mentee.
To attend a District training session before mentoring may begin.
To be on time for scheduled meetings.
To meet with my mentee for one hour per school week.
To notify the building coordinator if I need to reschedule my weekly meeting.
To keep discussions with my mentee confidential unless a student's safety is at risk.
To limit contact with my mentee to school grounds during the school year.
To participate in mentoring program evaluations.
To ask for assistance when I need help with my mentee.
 

 Please print a copy for your records before submitting.       



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