Cell Phone Number
General Information - This information helps us match mentors and host families with students who have similar interests and desires when possible
Are you applying as a mentor (individual) or host family (couples and families with children)?
Would you be more comfortable with male or female student?
Are you interested in adopting more than one student?
What local church do you attend?
Occupation and Educations
About you - hobbies/interests, community/organizations, etc.
Do you have any pets? If so, what kind?
Does your household have any restrictions due to COVID? If so, please explain.
Photo of you/your household
Name of Spouse/Housemate(s)
Occupation and Educations of Spouse/Housemate(s)
Name(s) and Age(s) of Children Living at Home
Name(s) and Age(s) of Children not Living at Home
Personal References - Please provide information for two personal references. One reference must be a church pastor/leader.
Reference 1 First Name
Reference 1 Last Name
Reference 1 Phone Number
Reference 1 Email
Reference 2 First Name
Reference 2 Last Name
Reference 2 Phone Number
Reference 2 Email
Completed Code of Conduct Form
Completed Responsibility Contract
Are you willing to consent to a background check? There is a $10.00 fee associated for each screening.
***If you are applying as a mentor, only you will need to consent to a background check. If you are applying as a host family, everyone in your household 18 years and older will need to consent to a background check.
Any other information you would like to share?