Mentor Profile

Name ___________________________________
Phone Number___________________________
4-H Mentoring: Youth and Families with Promise has general guidelines which assist in
matching mentors with a youth. The following information is gathered to assist the 4H/YFP Program staff in matching mentors to youth.
Age ______________ Gender _______________
Occupation________________________
If a student, what is your Major _________________
Name of your School _________________________
How do you classify your race? i.e. Caucasian, African American, Latino, American
Indian, Multiracial, etc. (Optional)__________________________
What is your religious affiliation?(Optional)______________________________
Do you speak a language other than English? Yes No
If yes, what language/s?____________________________
Do you have access to an insured vehicle Yes No
What are your career interests?
__________________________________________________________________
__________________________________________________________________
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How would you describe your personality? (i.e. easy going, fun loving, organized, task
master, etc.)
______________________________________________________________________
___________________________________________________________________________________________________
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Personal Interests:
What are your hobbies? Circle those that apply:
Stamp Collecting
Wood Working
Reading
Crafts
Computers
Scrapbooks
Photography

Model Cars or Planes

Sewing/Knitting, etc.
Insect Collecting
Baking/Cooking
Ceramics
Leather Crafts
Auto Mechanics

Card Collecting
Gardening
Rock Collecting
Painting/Drawing
Writing/Poetry
Pets/Animal Training
Electronics

Please list any other hobbies you have:__________________________________

What are your recreational pursuits? Circle those that apply:

Basketball
Baseball/Softball
Football
Tennis
Golf
Swimming
Wrestling
Skiing
Camping
Boating/Waterskiing
Hiking
Bicycling
Horseback riding
Roller-blading
Soccer
Volleyball
Archery
Fishing
Hunting/Marksmanship
Music
Dance
Theater/Arts
ATV/Motorcycle
Track and Field
Other_________________________________________________________________________
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AVAILABILITY
Circle the days and times of the week you could mentor:
Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

9:00 am
12:00 pm
2:00 pm
4:00 pm
6:00 pm
8:00 pm

9:00 am
12:00 pm
2:00 pm
4:00 pm
6:00 pm
8:00 pm

9:00 am
12:00 pm
2:00 pm
4:00 pm
6:00 pm
8:00 pm

9:00 am
12:00 pm
2:00 pm
4:00 pm
6:00 pm
8:00 pm

9:00 am
12:00 pm
2:00 pm
4:00 pm
6:00 pm
8:00 pm

9:00 am
12:00 pm
2:00 pm
4:00 pm
6:00 pm
8:00 pm

9:00 am
12:00 pm
2:00 pm
4:00 pm
6:00 pm
8:00 pm

Comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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________________________________________________________________________
Describe the type of youth you would like to work with:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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FEBRUARY 2012