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Mentor Checklist/Approval Form

(This does not substitute for forms required by your district)
This form is for documentation and follow-up, to be processed by Mentor Coordinator.
Name_____________________________________________________
Site_______________________________________________________
Home Address______________________________________________
Home Phone________________________________________________
Brief description of services to be performed:
Participation in the Mentor Program which may include field trips to sites of interest, assistance with school-related projects, career related research, attending conferences and other career-related events with students, and other events as planned in the Mentor Program.
Staff contact: __________________________________________________
________TB test submitted. Valid through ______________
________DMV report and "Volunteer Use of Vehicle" form submitted (if required)
________Vehicle Inspection completed. Date_____________ (if required)
________________________________
Principal's Signature for Approval
Date ____________________

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FOR DISTRICT OFFICE USE ONLY
________Fingerprint Card Submitted
________ Background Check Completed
Note: Volunteers may not provide services until this form is completed and on file in the principal's office.