|
State
of New Jersey
Commission
on
Higher
Education
P.O. Box 542
Trenton NJ
08625-0542 |
|
Governor |
Telephone: (609)
292-4310
Fax: (609) 292-7225
E-mail:
nj_che@che.state.nj.us
Web Site:
www.state.nj.us/highereducation |
Chairman |
Dear Potential NJ GEAR UP
Mentor:
Thank you for expressing interest in becoming a NJ GEAR
UP mentor. NJ GEAR UP (Gaining Early Awareness and Readiness for
Undergraduate Programs) provides educational support and assistance to middle
and high school students to help them prepare for and enroll in college.
Mentoring is an integral part of the program, allowing college students to share
the benefits of attending college with NJ GEAR UP students in Jersey City,
Newark, Camden, and Trenton.
The
recruitment, selection, and training process will include the following
steps:
1.
Application--Interested candidates must complete the attached NJ GEAR UP
mentor application.
2.
Background check--Applicants must complete the attached blue New Jersey
SBI 212B form so that a state background check can be performed.
3.
Interview--Selected applicants will be called for individual interviews.
4.
Training--Applicants who are accepted into the program must attend a
training session.
The
emphasis of NJ GEAR UP is primarily academic; therefore, your grade point
average may be considered in the selection process. Mentors should be able
to demonstrate the importance of academic performance to NJ GEAR UP students.
I
encourage you to share this opportunity with friends and other college
students. Please feel free to contact me if you have any questions or
concerns. Thank you for your interest.
Sincerely,
Kilpatry Cuesta
NJ GEAR UP Assistant State
Coordinator
Phone (609) 341-3807
kcuesta@che.state.nj.us
Administered by the New Jersey Commission on Higher
Education
Funded by the United States Department of
Education
Program sites at Mercer County Community College, New
Jersey City University,
Rowan University, and the Consortium for Pre-College
Education in Greater Newark (New Jersey Institute of Technology,
Rutgers University-Newark, and University of Medicine and
Dentistry of NJ)
for best results, please set all printer margins to
one-half inch.
NJ GEAR UP Mentor Application
Click for an online
version of the application you can fill-out online and submit
electronically.
Please print or type.
Part A: Personal Information
Name: (First,Middle Initial, Last)
________________________________________________________________________________________
Campus Address:
___________________________________________________________________________
__________________________________________________________________________________________
Campus Phone Number: _________________________________ Best time to contact
you: __________
E-mail address:
_____________________________________________________________________________
Permanent Address:
_________________________________________________________________________
__________________________________________________________________________________________
Permanent Phone Number: __________________ Can you be reached at home?
(Circle one) Yes No
Social Security Number: ______________________Driver’s License Number:
______________________
Date of birth: _________________________________________ Gender: (Circle one)
Male Female
Are you employed? (Circle one) Yes No How many hours per week are
you working? ___________
Employer’s Name:
_________________________________________________________________________
Employer’s Address:
________________________________________________________________________
__________________________________________________________________________________________________
Part B: Academic Information
University or College:
_______________________________________________________________________
Number of Credits completed: __________ Cumulative G.P.A: _________
Major: _____________________________ Minor:
_________________________________
Year in college: (Circle
one) Freshman Sophomore Junior
Senior
Have you participated in the EOF (Educational Opportunity Fund) program?
(Circle one) Yes No
If yes, at what institution?
____________________________________________________________________
Part C: Mentoring Preferences
Indicate the geographical area in which you are available to mentor: (Circle
one or more)
Trenton Jersey
City
Camden Newark
What month are you avaialbale to start?
________________________________________________
Are you able to be flexible with your schedule? (Circle
one) Yes No
Part D: Volunteer Experience
Have you ever been a mentor? (Circle one) Yes
No
If yes, please describe your experience.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Have you had volunteer or work experience with youth? (Circle one)
Yes No
Please explain.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What other volunteer experience have you had?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Part E: Interests and Special Skills
Are you involved in any extracurricular activities on your campus? (Circle
one) Yes No
Please describe.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What are your special skills (e.g., computer, math, leadership)?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What are your interests (e.g., photography, music, hiking, theater, sports)?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What are your career goals?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________<
Part F: Your Reasons for Becoming a NJ GEAR UP Mentor
Why do you want to become a NJ GEAR UP mentor?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What do you think you can bring to the mentoring relationship?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Part G: Background
Have you ever had an alcohol or drug abuse problem? (Circle one)
Yes No
If yes, please explain.
__________________________________________________________________________________________
__________________________________________________________________________________________
Have you ever been convicted of an offense other than a minor traffic
infraction? (Circle one) Yes No
If yes, please explain.
__________________________________________________________________________________________
__________________________________________________________________________________________
Part H: References
List two references who have known you for more than one year who can provide
a personal reference (e.g., teacher, college counselor, employer). Please do not
use your relatives.
1. Name: ______________________________________________
Years known: ___________________
Address:
____________________________________________________________________________
City: _____________________________________ State: __________________ Zip:
______________
Phone number:___________________________________ Relationship to
you:____________________
2. Name:______________________________________________ Years
known:_____________________
Address:
____________________________________________________________________________
City: _____________________________________ State: __________________ Zip:
______________
Phone number: __________________________________ Relationship to
you:____________________
As a NJ GEAR UP mentor, I agree to the following conditions:
- To undergo a criminal background check.
- To spend about five hours per week with NJ GEAR UP students.
- To make an initial six-month commitment.
- To work with NJ GEAR UP students under supervised conditions at all times.
- To work with NJ GEAR UP students during a probationary period until the
criminal background check is completed.
- To understand that I can be dismissed if the criminal background check
reveals a criminal offense that can adversely affect the program or NJ GEAR UP
students.
- To ask for assistance when I need help with the mentoring relationships.
- To work closely and cooperatively with NJ GEAR UP staff members during all
phases of the program.
- To notify NJ GEAR UP staff members and NJ GEAR UP students when I am
unable to keep my weekly commitments.
- To be on time for scheduled events.
- To attend training sessions.
- To maintain a good academic standing.
I do hereby understand and agree to the above commitments and
responsibilities and attest that all of the information I have provided on this
application is correct to the best of my knowledge.
_________________________________________ _____________________________
Signature,
Date
Where did you hear about the NJ GEAR UP mentoring opportunity?
__________________________________________________
Thank you very much for your interest in becoming a NJ GEAR UP mentor. We
appreciate your thoughtful attention to these questions, and we will schedule an
interview with you if your application is accepted.
Please mail the completed application to:
Kilpatry Cuesta
GEAR UP Assistant State Coordinator
NJ
Commission on Higher Education
P.O. Box 542
Trenton, NJ 08625-0542
Fax
(609) 292-7225
Administered by the New Jersey Commission on Higher
Education
Funded by the United States Department of Education
Program
sites at Mercer County Community College, New Jersey City University, Rowan
University, and the Consortium for Pre-College Education in Greater Newark (New
Jersey Institute of Technology, Rutgers University-Newark, and University of
Medicine and Dentistry of NJ)