Mentor Application

Mentor Application

Dear Potential Mentor, Thank you for taking the time to fill out this questionnaire. The questionnaire is vital to helping us understand you and your possible placement as a Mentor in our program. If you are accepted as a Mentor a considerable amount of time, resources, and commitment will be put behind you and the youth you will mentor over the next four years. Because of this investment we want to honor our donors and research each potential mentor to the best of our ability. Your responses help us determine how best we can serve you and your youth. Feel free to be honest. We are not greatly concerned about your past because your past makes you who you are today and can help you relate well to your possible mentees who are growing up in tough situations. As long as our mentors can pass random drug tests throughout the year we are open to having mentors with very colorful pasts. Be assured that the information you provide below will be kept strictly confidential. Ready to go? Great, tell us all about yourself!
  • Adverse Childhood Experiences (ACE)

    MUST understands that the following questions are very personal. If you do not feel like completing this section then feel total freedom to skip it. The answers to these questions are helpful in matching you, the Coach, to your potential Mentors but are not necessary. We measured the prevalence of ten Adverse Childhood Experiences (ACE), consisting of whether you, as a child, child ever experienced one of the following. Please answer the following questions regarding your childhood and keep a running tally in your head. At the end, please total the number of times you answer yes to any of these questions.

    1. Did a parent or other adult in the household often or very often… swear at you, insult you, put you down, or humiliate you? or act in a way that made you afraid that you might be physically hurt?

    2. Did a parent or other adult in the household often or very often… push, grab, slap, or throw something at you? or ever hit you so hard that they had marks or were injured?

    3. Did an adult or person at least 5 years older than you ever… touch or fondle you or have them touch your body in a sexual way? or attempt or actually have sex with them?

    4. Did you often or very often feel that … no one in your family loved you or thought you were important or special? or your family didn’t look out for each other, feel close to each other, or support each other?

    5. Did you often or very often feel that … you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

    6. Were your parents ever separated or divorced?,/p>

    7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

    8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

    9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

    10. Did a household member go to prison?