Swimming Upstream Mentor Application

SWIMMING UPSTREAM MENTOR APPLICATION

Empower teens to rise above life’s challenges!

Swimming Upstream is a transformative 4-week program designed to help teens navigate the rough waters of life through inspirational empowerment and life skills sessions. Since its launch 15 years ago, 100% of program participants have graduated high school!

MAKE A DIFFERENCE.Join us in lifting teens above social justice and racial equity barriers to help break the multi-generational cycle of poverty.

📞 Monica Ball – Board President

📧 monica@upliftsandiego.org | 📱 619-708-3512

Applicant Information:

Mentorship Interest

First name

Last name

Phone

Alternate Phone

Address (Address, City, State, Postal/Zip code)

How did you hear about us?

What language(s) do you speak?

What is your current occupation?

What is your previous experience working with youth or volunteering?

Have you ever been convicted of a felony? Background check may be required by the State of California.

Personal Reference Information

Personal Reference Full Name

Personal Reference Phone

Personal Reference Email

Personal Reference Relationship to Applicant

Emergency Contact Information

Emergency Contact Full Name

Emergency Contact Phone

Emergency Contact Email

Emergency Contact Relationship to Applicant

Demographics - some questions are requested for grants

Race

Ethnicity

Gender

Are you part of the LGBTQIA+ community?

VOLUNTEER TERMS OF SERVICE:

Please check each box corresponding to each statement, agreeing to the UPLIFT Volunteer Terms of Service, and provide an electronic signature.

CONSENT TO REFERENCE/CRIMINAL BACKGROUND CHECK:

I consent to permit UPLIFT San Diego to contact anyone it deems appropriate to investigate or verify any information provided by me to discuss my suitability for the Swimming Upstream Mentor program, including criminal background checks and personal references. By checking, I attest to the fact that I do not have a criminal history.

PUBLICITY RELEASE:

As a participant of the Swimming Upstream Mentor program, I consent to allow UPLIFT, and by extension UPLIFT's community partners such as the San Diego Council on Literacy and Live Well San Diego, to use my image and likeness for promotional and marketing materials, including but not limited to brochures, PowerPoint presentations, newsletters, and social media posts.

CONFIDENTIALITY AND MANDATED REPORTING:

As a participant of the Swimming Upstream Mentor program, I understand that all information pertaining to the assigned mentee is confidential between UPLIFT staff, the guardian, the school, and the assigned volunteer mentor. Child information is confidential except in instances of child abuse, elder abuse, an intent to harm oneself, or an intent to harm others.

TERMS OF SERVICE:I will attend and prepare materials for all mentoring sessions to the best of my ability. I will notify the Program Manager of absences as soon as possible. I will act as a role model to youth and follow all program policies and procedures as a Swimming Upstream Mentor.

Signature