Mentoring Connector
* - Required field

Program Basic Information
* Program Name
External ID #
EIN
Parent Organization
No Parent Organization
* Parent Organization
  
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Parent Organization
Parent Organization Email
Parent Organization Phone
Physical Location
* Address 1
Address 2
* City
* State
* Zip Code
+ 4 (optional)
County
Service Area
Number of sites/chapters this listing represents
* Does the program (not the parent organization) serve mentees and recruit volunteers in more than one state?
YesNo
* States Served, select all that apply
Social Media
Website
Types of Mentoring Opportunities Offered
* Types of Mentoring Opportunities Offered
Program Focus Area
Program Focus Area
Program Focus Area Other
Primary Meeting Location
* Primary Meeting Location
Description of Other
Other Meeting Locations
Other Meeting Locations
Description of Other
Goals
* Goals
Description of Other
Program Operated Through
* Program is run through a
Description of Other
Mentoring Program Description
* Mentoring Program Description
Program Administrator Contact info
Program Administrator Prefix
Program Administrator Prefix Other
* Program Administrator First Name
Program Administrator Middle Name
* Program Administrator Last Name
Program Administrator Title
* Phone Number
Program Administrator Phone Ext
Program Administrator Fax
* Program Administrator Email
* Create a Password for logging in to the Mentoring Connector
* Confirm Password
Volunteer Contact Within Your Organization
Volunteer Contact Prefix
Volunteer Contact Prefix Other
* Volunteer First Name
Volunteer Middle Name
* Volunteer Last Name
Volunteer Title
* Volunteer Phone
Volunteer Phone Ext.
Volunteer Fax Number
* Volunteer Email
Target Mentee Population
* Program Accepting Male Mentees
YesNo
* Program Accepting Female Mentees
YesNo
* Age of Youth Served
* Description of Other
* Family Structure
Description of Other
* Youth Served
Description of Other
Mentor Information
* Program Accepting Male Volunteers
YesNo
* Program Accepting Female Volunteers
YesNo
* Mentor Ages
Description of Other
* Mentor Description
Background Checks
* Conduct criminal background checks on mentors
YesNo
Background Checks - Detail
Fingerprint-based criminal background check
YesNo
Type of fingerprint-based background check
FBI Nationwide SearchState-only Search
Name-based criminal background checks
YesNo
Type of name-based background check
State-Only SearchLocal-Only SearchMulti-state Search
Other Registeries
Training for Volunteer Mentors
* Does your program provide training for volunteer mentors?
YesNo
Briefly describe the training you provide:
Match Commitment
* Minimum Match commitment in months
Contact Frequency
Description of Other
Average Hours per week
How did you hear of the Mentoring Connector?
How did you hear of the Mentoring Connector?
Description of Other