Mentor Program Interest Form

Interested in Being a Mentor?

A free program for families of children who are deaf or hard of hearing, ages birth to 5, to give families the opportunity to meet deaf or hard of hearing adults who have different experiences and varying educational backgrounds. Mentors meet with each family on a regular basis either at the family home, or remotely, to provide families with a positive and hopeful perspective from their own day-to-day, real life experiences as a deaf or hard of hearing person living in a hearing world. Mentors are training in American Sign Language (ASL) instruction and interact with children and families using ASL. They show family members how to use ASL through ASL lessons and informal interaction, teach families about deaf culture, and introduce them to the local deaf community.

Commitments/Relationships
How open are you to sharing your personal experiences and learning about the differences in values of your assigned families?*
For both mentors and role models, this program requires a one-year commitment. If you were to be selected, could you make a one-year commitment to this program?*

YesNo
Sometimes we may ask Mentors or Role Models to match with several families. How many total number of families would you be available for to commit to weekly visits with? (both face-to-face and remote). Please provide more information if needed under 'Other'.*

1234 or more

Please tell us the days and times that you would be available to work with families (check all that apply)*

Past Experiences
How many years of experience do you have in work related to being a Mentor or Role Model? (If none, please enter 0)*
How many years of experience do you have working with families, infants, and young children (birth through 5 years)? (If none, please enter 0)*
What is a recent example of something you successfully achieved as an Deaf adult?*

Personal Biography
Please provide a brief biography in your own words describing yourself and your background. *

Additional Information and Comments
Those who meet the criteria of becoming a Mentor will be required to pass a background check including fingerprinting. If accepted, do you foresee any potential problems with this process?

YesNo
If you have further information or anything you'd like to add that was not previously asked, please share below:
Please list any questions or comments you may have. We will respond via email.
Thank you for your interest in becoming a Mentor. After review of this form, we will contact you soon with more information.
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Interested in Being a Mentor?