Information form-Heart Gallery of Lane County

Mentor Program Volunteer Information Form

First Name:		Last Name:
Address:		City, State, Zip:
Phone:		Email:

1. Why are you interested in volunteering or being a Heart Gallery Mentor?

2. Why did you choose Heart Gallery Mentor Program, a program that works specifically with teenage foster youth?

3. Please tell us about any skills, hobbies, interests or personal strengths that you would be willing to share with a young adult (i.e. money skills, sports, art, health, organization, etc.).

4. What do you like to do in your free time?

5. How would you describe yourself?

6. Please tell us any circumstances in which you would be uncomfortable working with a young adult (i.e. if the young adult has experienced abuse, drug and alcohol issues, grief, and loss, etc.).

7. Is there anything else you think would be important for us to know about you or that you would like to add?

8. Is there any part of Independent Living skills that you feel you would like to help teach or educate a group about (i.e. banking, car care, study groups, applications, interviewing, job skills, resumes, apartment and housing, daily living skills (laundry, cooking, simple repairs) and all other tasks that a young adult will need to know how to do? (This can be a class, a flyer, a hands on event, a publication for ILP binder, video what ever you would want to put together (even if it is only a small part of the complete task).