C-CORE Mentoring Program Application

Welcome to C-CORE's online application to become a mentor. Thank you for making a difference as our youth work towards building a better life.

Before you begin, we highly recommend a full review of the application page to better determine what type of information should be submitted.

When completing the online application, it is important to use your legal name and complete the entire application. Fields which have an asterisk (*) are mandatory. Paper applications are available for anyone who does not have Internet access.

Please be prepared to provide detailed information on your background and interests and hobbies to help us determine the best possible match.

Once you submit your application to become a coach/mentor someone will be in contact with you within 48 business hours to provide you with more information.

As an added measure to protect C-CORE members (youth) safety, Home Builders Institute requires any person wishing to become a mentor agree to an extensive criminal background check. The criminal background check requires your full legal name, date of birth and social security number. This process will take place at the mentoring organizations offices prior to being matched. Your information will be kept strictly confidential and will not be shared with third-party viewers or outside agencies.

* - Required field.

HBI Online Mentor Application
Basic Information
* First Name
Middle Name
* Last Name
* Pick the Intermediary in the city where you would like to mentor
Contact Information
Home Phone
Work Phone
Work Phone Ext
May we contact you at work?
* Email Address
* Emergency Contact Name
* Emergency Contact Phone Number
* What is the best way to contact you?
Home Adress
* Home Address 1
Home Address 2
* Home City
* Home State
* Home Zip
Business Address
Business Address 1
Business Address 2
Business City
Business Name
Business State
Business Zip Code
Preferred Mailing Address
Mail to this address
* Date of Birth
* Gender
* Race
If other please specify Race
Languages you are proficient in besides English
Other Information
* Interests and Hobbies
* Reason for wanting to become a mentor
Referred By
* How did you hear about becoming a mentor?

If other please specify how you heard about the program
* Drivers License Number
* Is there anything that may preclude you from passing a background screening check?
References - If you are having trouble viewing all reference fields, please hold Ctrl and hit the - key for better formatting (Ctrl+ will revert to normal screen resolution).
Reference #1
* Ref 1 First Name
* Ref 1 Last Name
Ref 1 Address
Ref 1 Address 2
Ref 1 City
Ref 1 State
Ref 1 Zip
* Ref 1 Phone
* Ref 1 Relationship
Reference #2
* Ref 2 First Name
* Ref 2 Last Name
Ref 2 Address
Ref 2 Address 2
Ref 2 City
Ref 2 State
Ref 2 Zip
* Ref 2 Phone
* Ref 2 Relationship
Reference #3
Ref 3 First Name
Ref 3 Last Name
Ref 3 Address 1
Ref 3 Address 2
Ref 3 City
Ref 3 State
Ref 3 Zip
Ref 3 Phone
Ref 3 Relationship
Reference #4
Ref 4 First Name
Ref 4 Last Name
Ref 4 Address 1
Ref 4 Address 2
Ref 4 City
Ref 4 State
Ref 4 Zip
Ref 4 Phone
Ref 4 Relationship

Close Close Popup