HOPEWORKS 'N CAMDEN: Expanding the Futures of Youth

e-Mentor Application and Agreement

First Name:	Last Name:

Telephone:

Address:

City:		State:	ZIP Code:

Regular E-mail:	*This would be the email that you check regularly.

Alternate E-mail:	(If any)

Why do you want to become an e-Mentor?



Please describe any experience that you have in working with youth:


How did you find out about this program?



Can you use e-mail? yes no

Do you check your e-mail regularly? yes no

Can you check your e-mail at work? yes no

Please describe your educational background including the highest degree you have received and any areas in which you have majored or specialized.



Occupation:

Employer:

Job Title:

Describe a typical workday - a virtual office visit - so our trainees can have a sense of what you do.



In the space below, please type a brief paragraph describing yourself to help us match you with a trainee (hobbies, interests, etc.).



By entering your initials in the box below, you are agreeing to abide by the rules of the Hopeworks e-Mentoring Program. Specifically, you agree to: Never meet a trainee in person without consent of the formation director. Never to discuss vulgar, inappropriate or indecent topics. Always copy mentoring@hopeworks.org on all e-mails. Contact the formation director immediately if something of concern comes up in an e-mail. Initials:

By clicking 'Submit' below, you are certifying that the above information is true and accurate and that you wish to participate in the Hopeworks e-Mentoring Program. Your participation is subject to the approval of the formation director and Hopeworks reserves the right to terminate your participation at any time.

Hopeworks 'N Camden 543 State St. Camden, NJ 08102 Phone: 856-365-HOPE Fax: 856-365-8734
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