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Aspire Mentoring Program Application and Survey

  1. General Information
  2. Phone Type*
  3. If this is a cell phone, are texts okay?
  4. How did you hear about us?*
  5. Education and Employment
  6. References

    Please list three references including email and phone number so that we may contact them (no relatives).

  7. Statement of Agreement

    Please fill out the form below. A criminal background check is also required as a precautionary measure in protection of the Aspire Mentoring Program, the children/families we serve, and the city of Longview. That form will be completed at New Mentor Orientation. Read each statement, select, "Yes", and indicate agreement by your signature below.

  8. If you HAVE been convicted and/or placed on probation, please list date and nature of offense.
  9. List any states you have lived in besides Texas and how long you resided there.
  10. Mentor Survey

    This information will help us know more about you and allow us to match you with a Mentee that is compatible with you. Please fill this out as correct and honestly as you can.

  11. Gender
  12. Days that you could meet with your Mentee*
  13. Times that you could meet with your Mentee*
  14. Which age group are you interested in working with?*
    Select all that apply
  15. Would you have any concerns about with any of the following children?
    Select all that apply
  16. How would you describe yourself?*

    Select all that apply

  17. Leave This Blank:

  18. This field is not part of the form submission.