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Mentor Application

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List any current or past mentor / volunteer involvement

Do you speak a language other than English?
Do you own, or have reliable use of a car?
Do you hold current liability insurance?

I certify that I am currently maintaining Motor Vehicle Liability Insurance, as required by Texas Law. In the event such insurance is terminated or canceled for any reason, I agree to promptly notify you in writing. I further agree not to operate a motor vehicle in connection with my activities as a mentor until such insurance is reinstated. *Please include a copy of your insurance card you keep in your vehicle and driver’s license with this application.

Provide three references below, other than family members:


I authorize the verification of all information in my volunteer application. I give my permission for a criminal record check of my background and fingerprinting to be completed and reviewed by staff. I agree to provide additional information as needed to process my application and determine my suitability for the program.

I understand and agree that any omission, false statement, misleading statement or answer made by me on my application, any supplements to it or in any request for information from the Juvenile Department is cause for my dismissal from the mentor program. I understand that my information will be treated confidentially and only released if required by law.

I understand that I will be volunteering my time and will not receive any monetary compensation for my participation as a Program Mentor.

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Thank you! We’ll be in touch.

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