STEP UP Summer Mentor Application
Hope College Graves Hall B-07
(616) 395-7020
Summer Volunteer Mentors assist Step Up students (grades 6-8) during their summer day camp. Mentors will be matched with a small
group of students and will help this group with classroom/outdoor activities led by teachers and the program director. The program runs
MTWR June 29-July 23, 2015. Volunteers may assist on selected day(s) for morning and/or afternoon blocks (See times below).
Name _____________________________________________ E-mail Address ___________________________________________
Telephone: Cell ________________________________ Home/Local/Other (please specify) ________________________________
Mailing Address _____________________________________________________________________________________________
Student Status: ____ High School Student
For High School and College Students:
____First Year
____Sophomore
____ College Student
____ Junior
___ Other/Community Member
____Senior
Name of School: _____________________________
If applicable: College Major __________________________________
Minor _______________________________
1. Please briefly describe any previous work experience with children/youth in educational programs or tutoring (paid or volunteer):
__________________________________________________________________________________________
__________________________________________________________________________________________
2. Why are you interested in volunteering with Summer Step Up?
__________________________________________________________________________________________
__________________________________________________________________________________________
3. Please list your hobbies, skills, or special training that may help you in this volunteer position:
__________________________________________________________________________________________
__________________________________________________________________________________________
Personal Reference:
Name
Company/Department
E-Mail or Phone
_____ Yes, I speak another language (please list): ___________________________________________________________________
_____ Yes, I have been a STEP UP mentor in the past.
_____ Yes, I am using this placement for official service hours or a field placement. Organization:____________________________
I am available to volunteer at these times:
Days available:
___Mondays
___Tuesdays
___Wednesdays
___Thursdays
Times available:
____Mornings (9am-12pm)
____Afternoons (12pm-3pm)
1
I. STEP UP Summer Mentor Job Description:
STEP UP mentors are one of the most important elements of the STEP UP program. By volunteering to work with
at-risk youth, our mentors provide vital, caring mentoring relationships that encourage each student’s potential
for success. Your commitment to the following responsibilities is essential.
STEP UP Mentors will perform the following:
1. Attend Mentor Orientation and complete exit survey.
2. Mentor at minimum one (1) or more morning or afternoons per week for the entire summer session.
3. Be prepared to work by signing in on time.
4. Notify the STEP UP office if you will be late or unable to mentor on the day scheduled.
5. Focus on assisting and encouraging students with teacher-assigned activities during mentoring time. Abstain from personal
activities, including texting.
6. Encourage positive behavior in youth by modeling good listening skills and promoting an atmosphere of safety, mutual respect,
and acceptance.
7. Treat sensitive information from or about your students in a professional manner.
8. Discuss student progress, challenges, and behavioral concerns with the STEP UP staff.
9. Serve as role models for STEP UP students by promoting and displaying appropriate behavior and dress. Inappropriate behavior,
including public intoxication, use of illegal substances, abuse of legal substances, profanity, or harassment will result in immediate
termination.
10. Offer only appropriate comments to students about other adults (i.e. teachers, counselors, parents, and social workers) who provide
support in their lives, and promote the welfare of the STEP UP program by referring questions, concerns, or suggestions to the
STEP UP staff.
I have read, understood, and agree to follow the above STEP UP Summer Mentor Job Description.
Signature________________________________________________________ Date____________________________
II. Criminal Background Check – All Applicants
READ CAREFULLY --THIS DOCUMENT CONTAINS A RELEASE (non-certified)
As a prospective volunteer of STEP UP, I understand that it is this agency's policy to secure conviction criminal history information as
part of their pre-employment and volunteer participation screening process using the information provided below.
NAME:________________________________________________________________________________________________________
Last
First
Middle
BIRTHDATE:________________________________ RACE:______________________________________ SEX:_______________
I understand that the above information is required by the central records division of the Michigan State Police, Lansing, Michigan. I
authorize and unqualifiedly grant permission to STEP UP and its administration to make inquiries and to obtain any records from child
protection agencies, law enforcement and/or judicial authorities to determine whether any record of criminal conviction exists and whether
there are any felony charges pending against me, including the nature of the offenses. I understand that if I volunteer for STEP UP, this
consent form will become part of my personal file and that any misrepresentation, misleading or untruthful statement, or omission is cause
for dismissal should I become a participant in STEP UP.
I do hereby release STEP UP, its individual Board members, employees, and/or agents from any and all claims and/or liability
whatsoever for any damages or consequences which may result from the pre-employment investigation and/or physical examination,
including the drug screening test (if applicable), related to my consideration for participation in STEP UP programs.
Signature__________________________________________________________ Date ____________________________
III. Publicity Release – All Applicants
I give permission for STEP UP to use my image (photos, digital, video), sound recordings of my voice, and any materials that I submit
during my affiliation with STEP UP.
Signature________________________________________________________ Date ___________________________
IV. Parental Permission – Applicants under age 18 ONLY
I confirm that my child is under the age of 18 and that I give permission for him/her to volunteer as a STEP UP mentor.
Parent/GuardianSignature___________________________________________ Date ___________________________
Return to: STEP UP, 263 College Ave., Hope College Graves Hall B-007 PO Box 9000 Holland, MI
49422-9000 (616)395-7020 stepup@hope.edu www.hope.edu/stepup
2