FILL OUR THIS FORM IF YOU'D LIKE Be a Literacy Mentor. A MEMBER OF OUR STAFF WILL REACH OUT TO YOU WITHIN 48 BUSINESS HOURS ONCE YOU SUBMIT YOUR FORM!

Name *
Name
Sex *
Address *
Address
Preferred Grade-Level *
I am looking to mentor for the following amount of time: *
I understand that the mentor program involves spending a minimum of two hours every week for the duration of the agreed upon time. *
I understand that I will be required to complete the mentor program orientation and attend meetings and trainings as needed. *
Have you ever been convicted of a DUI? *
Have you ever received treatment for alcohol or substance abuse?
Have you ever abused a minor or engaged in any conduct that could be regarded as child abuse or neglect, including but not limited to murder, abduction for immoral purposes, sexual assault, failing to secure medical attention for an injured child, pander, crimes against nature involving children taking indecent liberties with children, neglect of children, obscenity offenses, or similar moral impropriety involving children? *
Do you agree to submit a criminal history background check to Chicago HOPES for Kids? *