Life Discipleship Mentor Application

Name

This address will receive a confirmation email

Phone

Preferred Method of Contact

Phone Text Email

Address

Gender

Church

Birthdate

Marital Status

Single Married Divorced Widowed Separated

Do you have children? How many? What ages?

What is your ethnicity?

Do you speak a language other than English? If so, what other language(s)?

Employer and/or Occupation

Any special skills or hobbies you would like to share which might be beneficial to a mentee or to our mentor group?

Do you have any past experiences that may make you a better match for certain mentees? (ex. teen parent, single parent, abortion, rape, multiples, etc.)

Do you have a history of abortion in your own past?

Yes No

If you have had an abortion, have you participated in a healing study? It is our greatest desire that our mentors receive healing as well as our mentees!

Yes No Doesn't Apply

Please describe your personality so we will know better how to match you with a mentee.(Are you outgoing, shy, take charge, sit back and wait, etc.)

Is there particular demographic that God has placed on your heart?

Why mentoring is on your heart?

What level of involvement do you want to have with a mentee? Do you feel equipped, called or prepared to handle a case with many needs or with fewer needs? All will need relationship as the base, but some mentees have greater needs than others (We will train you and provide a resource guide for services available in the area, regardless).

Do you consider yourself a Christian? If so, how long?

Briefly share your salvation experience.

What does it mean to be a Christian, and how do you believe someone becomes a Christian?

How would your faith affect your work as a Mentor?

Under what circumstances would you consider abortion as an alternative for a woman with a crisis pregnancy? Check all that apply.

Never Rape/Incest Medical/Life of the Mother

Provide at least one pastoral reference (name, phone and email)

Provide the name and email of a personal reference that you have known for at least 5 years.

Statement of Faith

Type your name here to signify that you agree with our Statement of Faith:

Confidentiality Agreement

Type your name here to signify that you agree to the terms of the Confidentiality Agreement above:

Mentor/Mentee Agreement

Type your name here to signify that you agree to the terms of the Mentor/Mentee Agreement above:

Life Discipleship Mentor Application

Description

Please Fix the Following