Mentor Application
The Esperanza Education Fund, Inc. is a community-financed college scholarship program founded and operated by
a diverse, all-volunteer group of young professionals in the capital region. Since our founding in early 2009, we have
awarded $125,000 in college scholarships to immigrant students in the District of Columbia, Maryland, and Virginia.
Unlike most scholarships of its kind, the Esperanza scholarship is open to all immigrant students regardless of
ethnicity, national origin, or immigration status.
In addition to helping our scholars pay for their college tuition, the Esperanza Education Fund offers its scholars the
opportunity to participate in an intensive academic and professional mentorship program. Interested scholars are
matched with local mentors who have similar professional interests. Each mentor-scholar pair’s relationship is
unique, but we encourage each pair to have regular contact over the phone and over email. In addition, we ask that
each mentor visit her scholar on-campus once a year and that each pair meet in person at least once a quarter.
A. MENTOR INFORMATION
Name: ___________________________________________________________________________________________
Contact Information:
Preferred Phone Number: (_____) _________________ Alternate Phone Number: (______) _______________________
Email: ___________________________________________________________________________________________
How can we best reach you?
□ Phone Call
□ E-mail
□ Text
Address:__________________________________________________________________________________________
_________________________________________________________________________________________________
Gender:
M□ F
□
Date of Birth: _____/_____/________
Language(s) Spoken:
Language:__________
Proficiency (Circle one):
Conversational
Intermediate
Advanced
Fluent
Language: __________
Proficiency (Circle one):
Conversational
Intermediate
Advanced
Fluent
Employment Background:
Place of Employment: _______________________________________________________________________________
Title: _____________________________________ Primary Industry __________________________________________
Brief Description of Job: ______________________________________________________________________________
_________________________________________________________________________________________________
Professional Interests: _______________________________________________________________________________
Educational Background:
Highest Grade Completed (please specify degree/major and year of graduation):
□ Some High School/GED
□ High School diploma: ________________________ □ Some College
□ College Degree (AA/BS/BA/Other): __________________________________________________________________
□ Masters: ______________________________
□ Law School: _______________________________________
Esperanza Education Fund Mentor Application
□ PHD: ________________________________
□ Medical School: ____________________________________
Schools/Universities Attended:
_________________________________________________________________________
_________________________________________________________________________________________________
What type of activities/organizations did you participate in during college (i.e., clubs, athletics, sorority/fraternity, study
abroad)?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Ethnic Background (Optional): _______________________________________________________________________
Special Interests and Hobbies: ________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
B. MENTOR EXPERIENCE
Please describe your experience, if any, working with youth. (Note: lack of experience does not disqualify you from
mentoring).
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Are you willing to visit your scholar at their college/university once a year? __ Yes __ No
Have you been an Esperanza mentor in the past? __Yes __No If yes, when? __________________________________
Why do you want to be a mentor? ______________________________________________________________________
_________________________________________________________________________________________________
How did you hear about Esperanza? ____________________________________________________________________
Do you have at least three hours a month to devote to a student?
___ Yes
___ No
What would you like to gain from your volunteer experience with Esperanza?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
The Esperanza Education Fund | P.O. Box 27507 | Washington, DC 20038 | info@esperanzafund.org
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Esperanza Education Fund Mentor Application
_________________________________________________________________________________________________
C. LEGAL HISTORY
*All information will be treated as confidential.
Have you ever been arrested?
___ Yes
___ No
If yes, please explain. ____________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Have you ever been convicted of felony?
___ Yes
___ No
If yes, please explain. ____________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Have you had any past or present problems related to abuse of drugs or alcohol? ___ Yes ___ No
If yes, please explain. ____________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
D. REFERENCES
*Please list two references – one (1) personal reference and one (1) from an employer or colleague
Name
Email Address
Phone number
1.
2.
___________________________________________
Signature
___________________________________
Date
*When submitting electronically, typing your name will serve as your signature.
To ensure a high level of safety and security for our scholars, Esperanza reserves the right to run background
checks on those individuals whom we select as mentors.
Thank you for your interest in volunteering with Esperanza!
The Esperanza Education Fund | P.O. Box 27507 | Washington, DC 20038 | info@esperanzafund.org
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