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Mentor Application

Mentor Application

All applicants must present the following on the day of their mentor interview:

  • Driver’s License
  • Current Auto Insurance
Mentor Information
Marital Status:
Any anticipated changes at work:
May Contact at work:
Health Issues:
Do you have reliable transportation:
How did you hear about us:
Mentor Requirements
Do you feel you can meet the minimum of spending at least 6-8 hours per month with a student?
Have you ever been convicted of a crime?
Do you smoke cigarettes or chew tobacco:
Do you anticipate moving from the area within the next 1-5 years:
Do you object to OJS checking with appropriate public authorities (e.g., police, courts, DMV, etc.) for matter of public record regarding your background/history?
Please check the activities below that interest you:
Do you currently volunteer with another organization:
Mentor References

* Please list two character references and one business reference. Please do not include family members

Reference 1
Reference 2
Reference 3

By submitting this form, I acknowledge that I have read, understand, and support the goals of Operation Jump Start. As a mentor, I look forward to being matched with a student who I will mentor for 1-5 years. I agree to follow all written rules and abide by all program obligations as presented.

Our Impact This Year

  • Students Served Since Inception


  • One-on-One Mentoring Hours


  • Scholarships Awarded


  • College Attendance Rate


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