The information supplied on this application will remain confidential within the Denver Kids, Inc. program. The parents/guardians of students in the program are considered part of Denver kids, Inc. program. (SSN, DL# and other personal information will never be shared.)

Denver Kids, Inc. is a member of the Denver Youth Mentoring Collaborative and may share the fact that you have applied to our agency.

Please note: Once you begin filling out the form you are NOT able to save your work and come back to complete at a later time. It may take up to an hour to complete this form so please feel free to print this page if you would like to take some time compiling all of the necessary information and return to this page to submit at a later time.
BASIC INFORMATION
Prefix
Application Date
First Name
Middle Initial
Last Name

Home Address 1
Home Address 2
Home City
Home State
Home Zip Code

Place of Employment
Work Address 1
Work Address 2
Work City
Work State
Work Zip Code

Home Phone
Work Phone    ext.   
Cell Phone
Email
May contact at work Yes  No 
Social Networking
Facebook
 MySpace
Birth Date
Marital Status
Spouse First Name
Spouse Last Name
ADDITIONAL INFORMATION
Have you lived at present address for less than 6 months? Yes  No 
If so, what was your previous home address:
How did you learn about Denver Kids, Inc.?
Have you ever applied to volunteer in an organization working with children and been refused? Yes  No 
If yes, please explain
Why do you want to be a mentor?
Previous involvement with children
What other close relationships do you have who might also be spending time with you and a Denver boy or Denver girl on a regular basis?
Have you ever been accused of child abuse, neglect, or child molestation? Yes  No 
If yes, please explain
Do you have a valid driver's license? Yes  No 
State
Do you consider yourself a safe and cautious driver? Yes  No 
Have you, in the last ten years, been issued a citation in connection with an alcohol or drug related offense under the moter vehicle code? Yes  No 
If yes, please explain
Have you ever had, or do you now have, a problem with drinking or substance abuse? Yes  No 
If yes, please explain
Do you consider yourself a law-abiding citizen? Yes  No 
Have you even been questioned, arrested, or had a complaint filed against you in connection with a crime? Yes  No 
If yes, please explain
Do you have an age preference?
How far are you willing to drive in order to pick-up your Denver kid?
Are there specific problems you would find difficult to deal with in working with a child?
Do you have any physical or emotional health issues that could impact your relationship with a child? Yes  No 
If yes, please explain
Do you have any allergies (animals, smoke, etc) that might impact how we match you to a student? Yes  No 
If yes, please note
We ask that all applicants to please provide us with two emergency contacts.

Emergency Contact 1
Name
Relationship
Phone

Emergency Contact 2
Name
Relationship
Phone

Please provide the names and mailing addresses of THREE references. (two personal & one business)

Reference 1
Prefix
First Name
Last Name
Relationship
Address
City
State, Zip
Phone Number
Email

Reference 2
Prefix
First Name
Last Name
Relationship
Address
City
State, Zip
Phone Number
Email

Reference 3
Prefix
First Name
Last Name
Relationship
Address
City
State, Zip
Phone Number
Email
BIOGRAPHICAL SKETCH
Nick Name
The best way to reach me is

Work
Where I work
What I do

School
Years in school (including post secondary)
Degree
Study
Do you speak a foreign language?
Fluency
My favorite subjects were/are

Hobbies & Interests
My hobbies include
Other things I like to do

Sports
The sports I like to participate in
The sports I like to watch are

Movies, TV & Music
My favorite movies
My favorite TV shows
My favorite music

Pets

People
The important people in my life are
My heroes are
What do you hope to gain from the mentoring experience?
I certify that all information provided herein is true and accurate. I understand that my application may be denied or my volunteer status immediately terminated if any information I have provided as part of this application process is found to be false.
EQUAL EMPLOYMENT INFORMATION
Denver Kids, Inc. is dedicated to equal volunteer and employment opportunities. We provide equal opportunities to all individuals based on job-related qualifications and ability to perform a job, without regard to age, sex, race, color, religion, national origin, sexual orientation or disability. It is our policy to maintain a non-discriminatory environment free from intimidation, harassment or bias based upon these grounds. Your response to this request is voluntary and refusal to provide it will not subject you to any adverse treatment. Data is used to fulfill statistical reporting requirements and to provide aggregate data to funders of the organization. Thank you for your assistance. (Please note that this page will be separated from your application prior to the screening process and will be kept confidential.)
Ethnicity
Gender
Education Level