References


In order to assess your suitability as a mentor we ask you to answer a number of personal and private questions in as open and honest a manner as possible. All information provided will be held in the strictest of confidence.

Name
Address

hereby acknowledge and agree that: I shall have no claim whatsoever against Bright Stars Mentorship Programme, a project of the Peace Agency (NPO 088/756) (“Bright Stars”)  or against its trustees, employees, agents and/or contractors for any  loss, damage, injury, accident, costs, expenses and/or other claims of whatsoever nature that I may incur and/or suffer, in respect of my person or property, arising directly or indirectly, in the course and scope of rendering voluntary service to Bright Stars, including by reason of any act or omission (whether negligent or otherwise and including gross negligence) by Bright Stars, its trustees, employees, agents and/or contractors.

I further acknowledge and agree that in the course of my mentor relationship with the child that I am matched with should it be discovered that I have at any time not disclosed the full truth about my criminal history and any allegations or convictions against me, that Bright Stars, its trustees, employees, agents, partners, funders and/or contractors will not be held liable for any damages, loss, injury, criminal allegations or convictions resulting from said non-disclosure.

Should it be found that I have been acting in a manner that is unbecoming of the role of mentor, and if any instances of sexual abuse, molestation or rape perpetuated by me on the child that I am mentoring, or any other child, are discovered, Bright Stars, its trustees, employees, agents, partners, funders and/or contractors are indemnified from any responsibility by virtue of the full and extensive criminal clearances that were required and provided by me, and the sexual offender’s affidavit that was sworn to by me.

Title
Phone
E-mail
Confirm E-mail


1. How do you know the person?
2. How long do you know the candidate for?
3. What is his or her greatest strength?
5. Does the candidate work well with children?
6. How does he or she handle conflict?
7. Comment on his or her ability to establish relationships
8. Comment on his or her self-knowledge
9. Is the candidate responsible? Please provide an example
10. Elaborate on his or her sense of commitment
11. How would describe his or her sense of integrity?
12. Will he or she make a good mentor and why?
13. Would you hesitate to match him or her with any type of child? Please explain
14. Is there anything further you would like to add
Your name
Location
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