Mentor Application

Thank you for your interest in becoming a mentor. Mentoring improves student success and positively impacts our community. Please fill out the application below.

Contact Information
Address
Please select your state above.
Please indicate if the address entered above is your home or work address.
Telephone
Choose multiple numbers by selecting and holding down the Ctrl key + clicking on your selection(s).
e.g. (555) 555-5555

*By providing your cell number, you authorize the College of Southern Nevada, the Clark County School District, and its partners to contact you via text with information about the Promise Program and the mentoring activities. This information will not be provided to others for any other use unrelated to the mentoring and community service activities at CSN/CCSD.

e.g. (555) 555-5555
e.g. (555) 555-5555
Professional Information
If your Company is not listed, please provide your company name above.

*CCSD current mentoring practices pair students by gender binary.

If your Professional Field is not listed, please provide your field above.
Please enter the major/specialty above.
Approved Mentor Information
CCSD Contact Information
e.g. jsmith@example.com
e.g. (555) 555-5555
*Acknowledgement and Background Check Release

Mentor Qualifications:

  1. The law that created the Promise Program requires all potential mentors to undergo a criminal background check. A person convicted of a felony cannot serve as a mentor.
  2. Mentors must be 21 years of age.
  3. Mentors may not employ the person being mentored.
  4. Mentors may not be related by consanguinity or affinity within the third degree to the students being mentored.
  5. Mentors also may not be compensated for their service.

Acknowledgement and Background Check Release

I acknowledge that a criminal background check is required by Nevada law to participate as a Promise Program mentor. I authorize the College of Southern Nevada to work with a third party vendor to conduct a criminal background check.

If for any reason I do not meet the background check requirements, the College of Southern Nevada will inform me in writing and will provide me with the information of the third party vendor so that I may contact them for further information.

I agree to complete the mentor application and authorize the background check electronically.

Employees of identified and verified partner organizations that conduct criminal background checks as a condition of employment, may be exempt from submitting to an additional background check. Employers will be notified of the desire of employee to apply to the program and will certify their employment and background check.

If my employer is one of the identified partners, I hereby authorize CSN to communicate with my employer to verify that I meet the requirements of criminal background check established for the Promise Program. I do so by electronically authorizing the verification with my initials below.

 

Having read the above, I submit this application electronically by clicking the submit button below.