APEXMentor Application

Please fill out the form below.

Thank you for your interest in the Teen Program! The Teen Program is a mentoring, educational, and support program for teens ages 13-18 who have been affected by the substance use disorder of a family member. The Teen Program is yearlong. It includes monthly after-school sessions held on Thursday evenings. The Teen Program follows a group and peer mentoring model. All teens and mentors make a one-year commitment to participate in the program. Mentors must attend at least eight sessions per year.

Applicant Requirements

The applicant MUST be 18 years of age or older.
The applicant is required to make a one-year commitment to attend at least eight sessions.

Screening Process

1. Submit an application.

2. Provide at least two references and participate in a phone/in-person interview.

3. Attend and participate in 3-hours of training each year.

Please check the boxes acknowledging that you have read and understand the commitment to become a mentor *

I understand that the Teen Program follows a group and peer mentoring model.
I understand and meet the applicant requirements
I understand that I must complete the application and screening process for consideration to be a mentor.

Application Information

Name *

First

Middle

Last

Preferred/Nickname (if any):

Age *

Date of Birth *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Preferred contact method *

Email
Phone

Time of Day

Employment

What is your current employment status? *

Full-time
Part-time
Not currently working
Retired

Company Name:

Job Title:

Are you currently enrolled in school? *

Name of School *

Major or Program: *

Highest level of education completed: *

What languages (other than English) do you speak? *

I have served or a close family member has served in the military (past or present) *

Have you volunteered or mentored for the Camp Mariposa youth program? *

How did you hear about the teen program? *

Briefly, why do you want to be a mentor with the Teen Program? *

Are there any conflicts or restraints that might make it challenging for you to participate in the program? *

Please describe any experience you have had with at-risk youth. *

Do you have any personal or professional experience working with adults/youth/families impacted by a substance use disorder or addiction? *

Please list any special skills you would like us to know about: *

Please check any that apply to areas you may be interested in leading or serving our teen population at the program sessions in addition to mentoring (check all that apply):

Tutoring – STEM
Tutoring – Humanities (English, writing, history, arts)
Leading small group activities (therapeutic)
Leading small group activities (mindfulness)
Leading small group activities (leisure, games)
Leading small group activities (crafts)
Session packing/setup (before and after sessions begin)

Have you ever been convicted of a crime?

Have you ever been investigated by Child Protective Services (CPS)? *

References

The Teen Program requires at least two references for all applicants. One of the references must be a professional reference. Please feel free to provide any additional references to help us ensure the completion of your application in a timely manner.

Name of Applicant: *

First

Last

Name of Reference: *

Relationship to applicant: *

Years known: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Preferred method of contact: *

Phone
Email

Time of Day:

Name of Reference: *

Relationship to applicant: *

Years known: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Preferred method of contact: *

Phone
Email

Time of Day:

Acknowledgement

I hereby certify that the information given on this form is factual and complete. I give my permission for any necessary verification. I release from liability any person and/or this organization giving, receiving, or utilizing any such information in making decisions regarding my application to become a mentor.

Applicant Signature: *

Date *

Want to Get Involved?

Aaron’s Place needs people like you to help as mentors, camp facilitators, and volunteers.

Overdose Lifeline, Inc. is an official provider of Aaron’s Place in the United States. Overdose Lifeline, Inc. is a nonprofit organization dedicated to prevention, advocacy, education, harm reduction, and support.

Visit Overdose Lifeline, Inc. website

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APEXMentor Application

Screening Process

1. Submit an application.

2. Provide at least two references and participate in a phone/in-person interview.

3. Attend and participate in 3-hours of training each year.

Application Information

Employment

References

Acknowledgement

Want to Get Involved?

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