J&J Leadership Academy Incorporated Volunteer and Mentor Application

Our Mission: To educate, empower, and transform minority male youth into positive change agents and leaders within their community and beyond.

Mentor & Volunteer Information

J&J Leadership Academy Incorporated is always looking for volunteers/mentors to join our
program and work with our youth. Where we know that volunteering may not be your full-time
position, it is very important that you are able to fully commit yourself before getting involved.
CONSISTENCY is one of the most important aspects of this program.

Please see below for some expectations of volunteers/mentors:

- Complete all J&J Leadership Academy Incorporated volunteer/mentoring training.
- Commit to at least two activities per month during the fiscal year; Activities/events can
include, but is not limited to the following; Saturday events, workshops, community service
projects, extra-curricular activities, guest speaking engagements, earned-incentive activities,
field trips, fundraising events.
- Complete a background check, and any additional standard procedures needed towards
working with youth. (There may be a charge for your background check.)
- If you are concerned about any flags on your background check, please feel free to discuss this
with J&J Leadership Academy Incorporated designee ahead of time. We understand that
mistakes may have been made in the past and this may not necessarily prevent you from
volunteering with our program.

Benefits towards being a volunteer/mentor with J&J Leadership Academy Incorporated are:

- Giving back to the community
- Being encouraging and supportive; showing how passions can be turned into success
- Providing our youth members with positive examples of what success can look like
- Providing a safe, trusting environment for our youth members to express themselves
- Assistance with teaching life and soft skills, and character development skills to the youth
members

J&J Leadership Academy Incorporated Volunteer and Mentor Application

Mentor Information

Full Name *

Date of birth *

Email *

Place of Employment *

Any allergies or medical concerns *

Hobbies and Interests *

J&J Leadership Academy Incorporated Volunteer and Mentor Application

Short Response Section

Why are you interested in becoming a mentor/volunteer? *

Have you ever been involved in a criminal matter? If so, please list all offenses for which you were charged and what the outcome of those charges were. Please exclude summary traffic tickets. PLEASE NOTE: All information is kept confidential. A personal experience in the justice system can serve as a testimony and may help relate more effectively to a young male as an insight to positive living. *

Please list the names and contact information of three references. (Not Relatives): *

J&J Leadership Academy Incorporated Volunteer and Mentor Application

Current Address

Address

Street Address *

City *

State *

Country *

Postal Code *

J&J Leadership Academy Incorporated Volunteer and Mentor Application

Emergency Contact Information #1

Emergency Contact information 1 *

J&J Leadership Academy Incorporated Volunteer and Mentor Application

Emergency Contact Information #2

Emergency Contact information 2 *

J&J Leadership Academy Incorporated Volunteer and Mentor Application

Emergency Contact Information #3

Emergency Contact information 3 *

J&J Leadership Academy Incorporated Volunteer and Mentor Application

Media Release Form

J&J Leadership Academy Incorporated wants to showcase what we do with the young males
in our program. We need your assistance to be able to do this. Please read below, sign and
date:

I authorize J&J Leadership Academy Incorporated to photograph me, take video footage of
me, and make electronic sound recordings of me.

I authorize the use of photography or electronic reproductions of me for any purpose,
including but not limited to educational and other public media purposes deemed
appropriate by J&J Leadership Academy Incorporated.

BY SIGNING THIS FORM, I AGREE TO THESE ABOVE-MENTIONED TERM

Mentor Information

By signing below, you are giving permission to J&J Leadership Academy Incorporated to
investigate and contact anyone of interest, who is appropriate, to verify the information
contained in this application. You voluntarily and knowingly waive all liability against all persons
providing and obtaining information for J&J Leadership Academy Incorporated, concerning your
application. By signing below, you also understand that this application does not create a
contract or employment relationship, nor a guarantee to be selected as a volunteer/mentor for
J&J Leadership Academy Incorporated. You also understand that any intentional falsification of
fact on this application can result in refusal of or separation from volunteer service.

Signature *

Clear

Date *