E3 Survival Skills for Life Mentor Application

What is your spouse's/family's reaction to the possibility of you becoming a mentor for E3? *

Have you ever been arrested for driving while intoxicated or driving under the influence? *

Yes No

Personal References: (known for at least one year)

(Please Note: Each person listed must be contacted and complete a short in person or telephone reference before the application can be approved.)

The undersigned acknowledges and agrees that:
(1) he/she is not obligated, if called upon to perform the volunteer services herein applied for, and that GMS or Amigo Centre is not obligated to assign, or actively seek to assign, him/her a mentor for the E3 program.
(2) as a part of the matching process with a mentee, additional information will be elicited from the applicant, and
(3) the above information is true and correct to the best of my knowledge