VOLUNTEER MENTOR APPLICATION

Full Name: Gender : M ( ) Address: F( )

Contact No: Relationship/Family: Married ( ) Single ( )

Email Id ( Provide 2):

Divorced/Separated ( ) If yes ages ------------------------------

Children : Yes ( ) No ( )

Local Languages Known Other Than English ( Can speak fluently) Kannada ( ) Tamil ( ) Telugu ( )

Any other Languages ------------------------Occupation : Employer/Organisation : Address of Workplace:

Contact Number : Type of Photo ID Proof Attached : Volunteering Experience:

Volunteered with Dream A Dream Programs

Yes ( ) No ( )

Have you attended an orientation/induction about Dream A Dream? Yes ( ) No ( )

If yes, provide details about volunteering role:-

Volunteered with Other NGOs/Non-Profits Yes ( ) No ( )

If yes, provide details about volunteering role:-

Do have any experience working with children? Yes ( ) No ( )

If yes, provide details:-

Why would you like to volunteer as a mentor in this program?

Can you acknowledge and confirm the following statements are true (Tick those true):-

I have not been involved in cases of criminal offences. ( ) I am not being treated for any mental health illness. ( ) I have not had any recent personal tragedy ( ) I do not suffer from any severe physical/health illness that may hamper me from volunteering. ( )

I hereby acknowledge and confirm that the above information is true and complete. Signature: