2015 TOPS Mentor Program Application

Transcription

1 2015 TOPS Mentor Program Application Thank you for taking your first step into becoming a TOPS Mentor! For millions of youth your interest in being a Mentor brings them one step closer to a caring, compassionate adult. It is our goal, with the help of people like you, to create a program to help guide today s youth down the path of successful completion of High School and College. To make a difference in the life of a child and to learn more about becoming a mentor, please read on and fill out the following application. TOPS Mailing Address: Ronnicia Johnson-Walker Boys & Girls Club of Dane County 4619 Jenewin Road Fitchburg, WI rjohnson-walker@bgcdc.org

2 AVID + TOPS = Success Developed in California, the AVID program is currently in over 3,000 schools nationwide. The original California program has 98% graduation rates and 95% of students who go on to college. The AVID curriculum is only in four other Wisconsin high schools outside of MMSD. The TOPS program is modeled after the Sponsor-A-Scholar Program in Milwaukee, which also has 95% + graduation rates and 98% going on to college. In 2008, the BGC received funding commitments of $2.6 million over 5 years, representing 65 % of the cost of the program over the first five years. East High School implemented the AVID Program independently in the fall of 2007 and the AVID /TOPS Program in the following school year. Starting in the fall of 2009, the AVID/TOPS Program expanded to all four Madison High Schools including East, LaFollette, Memorial, and West. AVID Program Components: Curriculum: The AVID program is a rigorous in-school elective that students take throughout high school to their improve study skills, grades, time management, reading and writing skills to better prepare them for college. College guidance/applications: Through the high school guidance counselors, all students get assistance in knowing what courses they need to take to be ready for college and what different schools require. They will get extra help in researching college choices, filling in applications, and applying for scholarships and financial aid. TOPS Program Components: Mentoring: All students will have the opportunity to be matched with a mentor in their sophomore year. Mentors will be expected to meet with their students at least once a month. Mentors will be trained and focused on helping students successfully complete high school, explore career options and enter college. Summer Job Internships: All students in the program will have the opportunity to participate in a paid summer job internship once they turn 16 (following their junior or senior year). They will complete the BGC Job Ready program before starting the internship. Career Exploration: The summer after their sophomore year students have an opportunity to learn about a variety of careers through Career Exploration. The learning process is enhanced by visiting Madison area employers and creating a personal career reflection over the six week summer program. College Continuation: The College Continuation program is a support network that helps students transition from high school to college and links students who are struggling in college with resources on their College Campus. AVID/TOPS Shared Components: Field Trips: Students will participate in 3-6 field trips throughout the year and the summer. Through these trips, students will have the opportunity to visit college campuses and focus on career exploration. Tutoring: Tutors will be available two days per week during the AVID class. BGC will recruit, hire and facilitate the training of both volunteer and paid tutors. Assessment: Monitoring of high school grades, high school graduation rates and college success will be instrumental in making sure that the program is working. AVID/TOPS has partnered with WISCAPE (Wisconsin Center for Advancement of Postsecondary Education) to develop an overall program assessment.

3 Mission Statements: AVID AVID's mission is to close the achievement gap by preparing all students for college readiness and success in a global society. AVID s systemic approach is designed to support students and educators as they increase schoolwide/districtwide learning and performance. TOPS Teens of Promise (TOPS) will significantly increase the number of under-represented high school students who go onto college and earn post-secondary degrees by providing academic and personal support.

4 Mentor Responsibilities The AVID/TOPS program recognizes that many of the program s students have multiple barriers in getting to college and succeeding once they get there. Having positive role models in their lives will greatly increase students likelihood of success. Many of these role models are provided through the AVID/TOPS program in the form of teachers, TOPS Student Coordinators, and tutors. TOPS takes it one step further by training community volunteers as mentors and matching them with interested AVID/TOPS students. The following are requirements for the TOPS mentors: Must have a college degree themselves. Must be dedicated individuals who want to spend some of their spare time working with an AVID/TOPS student, encouraging them to do what it takes to get to college. Must be willing to meet with their Mentee at least once a month. Serve as a positive role model for their Mentee. Successful mentors will: Communicate regularly with their mentee by phone, text, , or any other communication medium that works for them. Work with their mentee to set goals for their relationship, discussing the role that academics, college planning, and/or other personal goals will take during their time together. The TOPS Student Coordinator will be in regular contact with both the mentor and the mentee to track the progress of the relationship and provide guidance when needed. The program also schedules monthly group activities, which provides opportunities for mentors and mentees to spend time together without the stress of coming up with activities. The TOPS program does what it takes to create an environment where the mentor relationship can thrive.

5 TOPS Mentoring Program Mentoring Application, Screening, and Training The following procedures have been established for the selection of mentors for the Teens of Promise (TOPS) Mentoring Program. These procedures are in effect in order to provide for the safety and well being of both the mentors and students who participate in TOPS and to ensure the integrity of the program. 1. Completion of the TOPS Mentor Application The application includes space for listing of three (3) businesses or professional references, one of whom should be the applicant s present supervisor or professional associate. All information in the application is confidential. 2. Completion of the Consent to Cause a Criminal Records Check A Criminal Records Check is conducted through the State of Wisconsin. Also, a driving record check is conducted and the applicant may be asked to submit proof of current auto insurance. Information contained in the completed checks is reviewed by the TOPS Program. Any information of a nature that questions the ability of the mentor to work safely with a child will be reviewed with the mentor by TOPS Student Coordinator. 3. Interview with TOPS staff Each new mentor will have brief interview with the staff person responsible for his/her site to determine the best match possible. 4. Completion of New Mentor Orientation The applicant must complete a two and a half hour orientation covering an overview of the program, the basics of how to get started, and resources to help build your relationship. A TOPS Mentor Handbook will also be distributed. No Mentor will be matched with a student until the above are completed.

6 2014 TOPS MENTOR APPLICATION (PLEASE TYPE, OR PRINT NEATLY IN BLACK or BLUE INK) Last Name: First Name: Street Address: (Please include any unit or apartment numbers) City: State: Zip Code: Phone Number: Preferred Date of Birth / / Social Security number: / / (Necessary for required background check) The following information will be used in the matching process and for evaluation demographics: Gender: Female Male Race: Current Employer: Business Phone: Business Address: City: State: Zip Code: Position Held: Length of Time with Employer: Previous Employers (if less than 5 years with current employer): Please list previous Volunteer experience: Please list any clubs or organizations of which you are presently a member of: Have you had any previous experience working with teens? Yes No If yes, Please explain: What are some of your interests, hobbies or skills? Do you speak any foreign languages fluently? Yes No If yes, what language(s)?

7 Do you have a college degree? Yes No What institution(s) did you attend? What did you study? Are you able to commit to this position for one year? Yes No Do you have any prior or pending arrests or convictions? Yes No If yes, please explain, (answering yes will not automatically disqualify you as a mentor.) How did you hear about the TOPS Mentoring Program? Do you have a school preference? Yes No If so, where: West East LaFollette Memorial Please list three business/personal references. Please list a valid address if possible. Reference 1 Reference 2 Reference 3 Name: Address: City, State, Zip: Phone: Relationship: Please sign below to indicate that all of the information you have recorded on this application is accurate to the best of your knowledge. Signature: Date:. All information contained in this application is confidential. For more information or questions, contact Langston Evans at levans@bgcdc.org or Send to: Boys & Girls Club of Dane County, 4619 Jenewin Road, Fitchburg, WI Attn: Langston Evans

8 CONSENT TO CAUSE A CRIMINAL HISTORY RECORDS AND DRIVER S CHECK As a condition for participating as a mentor in the TOPS program, I authorize the TOPS Program to cause a Criminal History/Records and Driver s Check to be done by the State of Wisconsin. I understand that records may also be checked at the City and/or Federal level. I authorize the release of this information to the TOPS Program and will hold harmless the TOPS Program and any law enforcement agency personnel gathering this information. I understand this release will allow the TOPS Program to cause a Criminal History/Records and Driver s Check every two (2) years from the authorization date, as long as I am a standing volunteer position with the TOPS program. Name (please print clearly) (Last) (First) (Middle) Maiden Name or Any Other Name Used: Date of Birth: / / Race: Social Security Number / / (Necessary for required background check) Gender: Female Male Driver s License Number: State: If Driver s License is from a state other than WI, please include the address listed on the Driver s License below: Do you have any prior or pending arrests or convictions? Yes No If yes, please explain (answering yes will not automatically disqualify you as a mentor). Signature: Date of Authorization (Today s Date): / /

9 PHOTO RELEASE I grant permission to the Boys & Girls Club of Dane County to use photographs taken of myself, for use on Boys & Girls Club of Dane County and/or AVID/TOPS website, print materials or other electronic form or media without notifying me. I hereby waive my right to inspect or approve the photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, I have waive any right to royalties of other compensation arising from or related to the use of the photographs. I hereby agree to release and hold harmless the Boys & Girls Club of Dane County from and against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to any re-use, distortion, blurring, alterations, optical illusion or in composite form, either internationally or otherwise, that my occur or be produced in production of the finished product. I am 18 years of age, and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable of the terms of this release. Name: Address: City: State: Zip Code: Signature:. Date: / /

10 DRIVING INTENTION FORM Name: Date: Please check one: I would like to be authorized to drive my mentee during the course of our relationship. I understand that to be eligible to drive my driver record check must meet program standards. I am also required to provide my personal insurance carrier and policy number to the program. I understand that my mentee has the right to decline a ride from me at any time for any reason. Automobile Insurance Carrier: Automobile Insurance Policy Number: If my automobile insurance is cancelled or changed, I understand that I must notify the program immediately. I do not wish to drive my mentee. By checking this option, I understand that if at anytime I wish to drive my mentee I will need to undergo the program procedures for driving eligibility. Mentor driving checks will be run every two years for updated reports. Mentor Signature: Date: