Become a Mentor with ROP!

First name: *

Last name: *

Address: *

City: *

State: *

Zip: *

Home phone:

Cell phone: *

Email: *

Marital status: *

married

single

widowed

divorced

Are you a member of FCBC?: *

Yes

No

If yes, which ministries are you involved in?:

If no, list all churches you were a member of or attended in the past 5 years::

Have you been a child/youth worker, instructor, or volunteer before?: *

Yes

No

List your mentoring experience. Include the name of the organization, length of involvement and phone number of the organization or reference.: *

Why do you want to mentor with the Rites of Passage Program?: *

We are primarily a Saturday based ministry. Are you available on Saturday's?: *

Yes

No

Do you have any training/certification in First Aid or CPR?: *

Yes

No

Is there any circumstance that might call into question you being entrusted to work on be in contact with children or youth?: *

Yes

No

If yes, please explain.:

Have you ever been accused, convicted, or pleaded guilty/no contest to sexual misconduct or abuse involving minors?: *

Yes

No

If yes, please explain the circumstances.:

Do you certify that all information on this application is true to the best of your knowledge?: *

I do.

Ministries