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Alder Elementary School has a large population of students who face economic barriers in a diverse multilingual and multicultural area. We hope to
strengthen these students’ aspirations for university achievement at an early age through our MAPS (Mentor: Alder & Portland State) mentoring
program and partnership with Together We Are Greater Than (formerly I Have a Dream Oregon). The MAPS program is hosted by the Student
Community Engagement Center. Transportation is provided by a generous sponsorship from Zipcar. Mentors will be trained during November 2018
and will be matched with their mentee for Winter/Spring 2019 terms.
Priority Deadline to apply for the MAPS program: Friday, November 2, 2018.
The information you provide in this application will be used to assure SCEC is pairing and recruiting the best mentors for our group mentoring
program. Please provide as much information as possible.
For more information or questions, please feel free to email, Alec Martinez at alec5@pdx.edu.
What is the best method to contact you (ex. text message, email, etc.)? [Required]
[ ] Yes
[ ] No
[ ] Freshman
[ ] Sophomore
[ ] Junior
[ ] Senior
[ ] Graduate
We request that you make a commitment as a mentor. In order to be a strong mentor and build a relationship the student needs to be able to rely on
you showing up each week. We ask that no more than 2 days per term missed. Can you make that commitment? [Required]
Valid input:
- Select only one choice.
[ ] Yes
[ ] No
Short Answer
Page 1 of 3 · 2018/2019 MAPS (Mentor: Alder & Portland State) Mentor Application
As a MAPS mentor you will mentor an elementary school student individually and in their classroom. Why are you interested in being a mentor with
the MAPS program? [Required]
Do you have any experience working with youth/kids? If so, please explain below. [Required]
Do you speak any languages other than English? If so, please list languages and proficiency level.
What is your planned area of study? Why? Please feel free to describe your current career goals. [Required]
Do you have any accommodations the mentor program should know about?
[ ] Yes
[ ] No
References
Please list the names of two (2) professional references who can attest to your character, skill and dependability along with their phone numbers and
your relation/connection. Some example may be volunteer supervisors, professors or employment supervisor. [Required]
Page 2 of 3 · 2018/2019 MAPS (Mentor: Alder & Portland State) Mentor Application
I have read and agree to the following statement: [Required]
Statement and Assumption of Risk: Participation in the Activity can be hazardous to my health. I understand that I have an increased chance of suffering personal injury,
including but not limited to bodily harm, permanent disability, dismemberment, and/or death by participating in the Activity. Injuries that I might incur include, but are not
limited to the following: flesh wounds, muscular-skeletal injuries, cosmetic injuries, permanent disabilities and other injuries including death and or dismemberment. I
understand that traveling to and from the Activity site may present additional risk of serious injury or death, and agree to comply with Activity requirements for the use of
seatbelts by vehicle passengers during travel. I voluntarily undertake the Activity and agree to accept all risk associated with my participation in this Activity. Release of
Liability and Indemnification Statement I understand that there are unavoidable risks involved with participation in this Activity, and I, individually, and on behalf of my heirs,
successors, assigns, and personal representatives, hereby agree to indemnify and hold harmless and release and forever discharge the State of Oregon, the Oregon Board
of Higher Education, the Oregon University System, PSU, and their officers, employees, agents, and representatives, from any and all liability and all claims and causes of
action whatsoever for any damages to or loss of property, personal illness, or injury (including death) caused by, deriving from, or associated with my participation in the
Activity.
Valid input:
- Select only one choice.
[ ] I Agree
[ ] I Agree
[ ] I Agree
All volunteers must pass a criminal background check. If you have any questions or concerns please contact Alec Martinez at alec5@pdx.edu.
[ ] I Agree
Thank you
Thank you for your interest in volunteering with the Mentors: Alder and Portland State program. I really appreciate your interest and enthusiasm for
working with these students. Thank you for your time and I will get back to you as soon as I can regarding next steps.
Make sure to hit continue on this page, and click "Finish" to submit your application on the following screen.
Please feel free to contact Alec Martinez with any questions! Thank you!
alec5@pdx.edu
Page 3 of 3 · 2018/2019 MAPS (Mentor: Alder & Portland State) Mentor Application