Stay in School Mentoring Project Application

How to Become a Mentor

Personal Information

Employment Information

Personal References

Mentor Questionnaire

Mentor Interest Survey

Mentor Release Statement
    I, the undersigned hereby state that if accepted as a mentor, I agree to abide by the rules and guidelines established by the Stay In School Mentoring Program and the Clark County School District. I understand that the program involves
      A. Application and reference/background checks;
      B. Background check;
      C. Interview Questionnaire;
      D. Training/orientation session;
      E. Commitment of one hour per week for one school year;
      F. Communication with school personnel or project coordinator, and
      G. Completion of an end of the year survey.

    I understand that the Stay In School Mentoring Program and the mentor/mentee relationship established must take place only within the confines of the school in areas designated by school personnel. Contact or activities outside of the school are not permitted at any time.

    The information supplied in this application may be verified, if necessary, by contacting individuals or organizations regarding information contained in this application. I hereby release and hold harmless from liability any person or organization which provides information. I also agree to hold harmless the Clark County School District, Partnership Office, employees and volunteers thereof.

    I certify that all information provided on this application is true and complete to the best of my knowledge. I understand that the mentoring program must protect and serve the safety and well-being of the students. As a result, the mentoring program reserves the right to refuse participation and/or terminate applicants/mentors at any time, at the discretion of the CCSD. I hereby grant CCSD permission to verify all information supplied in this application through contact with individuals, organizations, law enforcement agencies and child protective services.