TEN:14 Mentor Application

Thank you for your interest in serving with MBC Arlington's TEN:14 ministry!

Once you submit this application, please submit a volunteer background check consent form within three days of completing this form. If you have any questions about this ministry, visit mcleanbible.org/connect/ten14-ministry or contact ten14ministry@mcleanbible.org.

*Address Line 1
Address Line 2
*Zip/Postal Code
*Date of birth:
*Mailing Address line 1:
Mailing Address line 2:
*ZIP code:
Daytime Phone Number:
Evening Phone Number:
*Do you attend a campus of McLean Bible Church? If so, which one?:
*Have you attended the Front Door class?:
*If yes, when?:
*How long have you been attending MBC?:
*Have you worked with children before?:
*What age range are you interested in mentoring? Enter all that apply (5-8 yrs old, 9-11 yrs old, 12-14 yrs old, 15+ yrs old):
*Why do you want to become a mentor?:
*Do you have a specific child with whom you have a connection and are interested in mentoring? If yes, why?:
It is necessary that you are able to fulfill the TEN:14 Mentoring Program Commitment: Minimum 6 month commitment:
- Meet with a mentee a minimum of 1-2 times per month, no less than 2 times per month in the first 3 months - Participate in organized mentor community building and training activities - Communicate regularly with mentor relationship coach
*Have you attended college or trade school?:
*If so, what was your major or focus?:
*What is your occupation?:
*Write in any that apply: attending plays/dramatic productions, dancing, drawing/painting/graphic design, writing, computers/video games, museums, movies, reading, exercise, basketball, soccer, football, tennis, cheerleading, hiking, shopping, singing/playing musical instruments, cooking/eating out, listening to music, etc.
*Do you have children?:
If yes, how many? Please list ages:
*Do you have any roommates or housemates?:
If yes, how many? Please provide names, ages, and genders:
*Do you imagine yourself with a talkative child, or someone more on the quiet side?:
Do you speak any foreign languages?:
If yes, please list languages and your level of proficiency:
*What kind of personality traits might be challenging for you?:
*Do you have guns/ammunition in your house? (If yes, we will discuss what safety precautions are necessary.):
*Do you have any pets? :
If yes, please list:
*Have you ever volunteered at MBC? :
*Please provide a copy of your proof of auto insurance via email to brittany.tress@mcleanbible.org
*Have you been involved in any accidents?:
Were you at fault?:
*Has any company cancelled or refused to provide you car insurance?:
*Has your driver's license been revoked, suspended, or restricted?:
*Have you had any moving traffic violations?:
*Do you have any medical conditions or disabilities that would limit your participation?:
If yes, please explain:
*Do you have any allergies?:
If any allergies, please list::
*Have you ever been arrested?:
If you have been arrested, please explain::
*Have you ever been convicted of a felony?:
If you have been convicted of a felony, please explain:
*Have you had any past/present problems related to abuse of drugs or alcohol?:
If you have had any history related to drug or alcohol abuse, please explain:
Is there anything else you would like to share about yourself? Please share below::
*Personal Reference #1 Name (must be a spiritual leader, volunteer ministry leader, or fellow volunteer.:
*Personal Reference #1 Relationship:
*Personal Reference #1 Phone Number:
*Personal Reference #1 Email:
*Additional spiritual leader or co-laborer, job/volunteer supervisor, college professor, mentor, accountability partner, friend, etc.
*cannot list family members
*Personal Reference #2 Relationship:
*Personal Reference #2 Phone Number:
*Personal Reference #2 Email:
*Please list consistent availability to meet with mentee (Ex: Tuesday evenings, Saturday mornings):

The information contained in this application is correct to the best of my knowledge. I give my authorization

to the MBC staff or its representatives to release any and all records or information relating to working with

minors. MBC may contact my references and appropriate government agencies as deemed necessary in

order to verify my suitability as a youth worker. I understand that the core leadership team will hold the

personal information in this application confidently