Potential Mentor Screening Intake Form

admin, please complete this P.m.s. intake form throughly & thoughtfully. The overall goal is to get to know our future mentors! Please check mark this section in the mentor onboarding doc.

Your Name

First Name

Last Name

SID Email

Todays Date

Date which P.M.S. is occurring

YYYY

Did you mention this call is being recorded?

Yes

Applicant Information Review

Please VERIFY This Information with them before moving to the next section.

Name

First Name

Last Name

Phone

(###)

###

####

SCC

Home Address

VERIFIED?

YES

QUESTIONS:

Tell me about a significant event(s) that have shaped your life?

What did you do well in school?

Who is the person in your life that you are closest to?

How would this person describe your personality?

What would others say that they do not like about you?

What continuously motivates you to keep moving?

Did/Do you have mentors? (Past/Current)

How do you feel about ethnic, religious, and racial differences that our Country/World faces today?

How open do you feel about sharing personal values and learning about the differences in values between the students?

Why do you want to be a mentor?

Do you understand the amount of commitment involved and believe that you can meet that?

Yes/No

What could hinder you in being a committed mentor?

Anything else you'd like to mention?

If you can think of any additional or follow up questions for them, please list the questions and their answers here

Not required but preferred

If they had any follow up questions that you could not answer, please list them here

Ask to see if they have any questions

How long did this session take?

At the end of the session, just mentioned to them that Administration will take the next couple days to review and our leadership team will be reaching out for further steps.