Personal Information
* First Name:
* Last Name:
* Street Address:
Apt No:
* City:
* State:
Choose a state
Alabama
Alaska
American Samoa
Arizona
California
Arkansas
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (U.S.)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
* Zip Code:
* Home Phone:Example: 5133635200
Cell Phone:Example: 5133635200
Work Phone:Example: 5133635200
* Date of Birth:
01
02
03
04
05
06
07
08
09
10
11
12
/
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
* Email Address:
Employment
* Employment Status:
Choose your work status
Working Full Time
Working Part Time
Homemaker
College Student
Retired
Unemployed
* Job Title/Position:
Company:
Street Address:
Suite No:
City:
State:
Choose a state
Alabama
Alaska
American Samoa
Arizona
California
Arkansas
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (U.S.)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Education
* Indicate highest level of education:
Choose highest level of education
High School Graduate
Attending College
College Graduate
Graduate School
Degree:
Previous Experience/Skills
Please describe your previous experience below
What previous Volunteer Experiences do you have?
* What motivates you to be a volunteer?
* What special skills, training, hobbies, or interests do you have?
Tell us about a positive role model in your life, and how they helped you.
Optional Information
For nondiscrimination reporting purposes only
Gender
Choose your gender
Female
Male
Age
Choose your age range
Under 18
18-24
25-34
35-49
50-64
65+
Race
Choose your race
Asian
Black
Hispanic
White
Other
Preferences
Please choose either an area to volunteer in or pick a specific school
Location:
West Northwest Downtown East Northeast
* Grade Level:
No Preference
K-6
7-8
9-12
College
Describe your ideal mentee's personality:
Do you have a preference on your mentee's ethnicity?
No Preference
Asian
Black
Hispanic
White
Other
Do you have a specific student in mind whom you’d like to mentor?
School Preference
No Preference
Academy of Multilingual (AMIS)
Academy of World Languages (AWL)
Aiken New Tech
Bond Hill Academy
Carpe Diem-Aiken
Carson School
Chase Elementary
Cheviot School
Cincinnati College Prep Academy
Clark Montessori
College Hill Fundamental Academy
Covedale School
Dater High, Gilbert A.
Dater Montessori School
DePaul Cristo Rey High School
Douglass School, Frederick
Evanston Academy
Fairview-Clifton German Lang. School
Finneytown High School
Gamble Montessori, James N.
Hartwell School
Hays-Porter School
Hughes STEM High School
Hyde Park School
Kilgour School
Midway School
Mt. Airy School
Mt. Washington School
North Avondale Montessori School
North College Hill High School
Norwood High School
Norwood Middle School
Oyler School
Parker School, John P.
Parker Woods Montessori School (Winton)
Pleasant Hill Academy
Pleasant Ridge Montessori School
Price Academy, Rees E.
Purcell Marian High School
Riverview East Academy
Roberts Paideia Academy
Rockdale Academy
Roll Hill Academy
Roselawn Condon School
Rothenberg Preparatory Academy
S C P A (School Creative Performing Arts)
Sands Montessori School
Sayler Park School
Shroder
Silverton Paideia Academy
South Avondale School
Spencer Center
St. Joseph School
Taft (Elem) School, W. H.
Taft Information Technology, R.A.
Taylor Academy, Ethel M.
University of Cincinnati - Blue Ash
Virtual High School
Walnut Hills High School
Western Hills University
Westwood School
Whitaker Elementary School
Winton Hills Academy
Withrow University
Woodford Paideia Academy
Woodward Career Technical
* Are you intested in Co-Mentoring?
Select one
No
Yes - with no experience, but willing to be trained
Yes - with little experience
Yes - with some experience
Yes - with a lot of experience
* Would you be willing to mentor a court involved youth, and if so, what level of experience do you have?
Select one
No
Yes - with no experience, but willing to be trained
Yes - with little experience
Yes - with some experience
Yes - with a lot of experience
* Would you be willing to mentor a youth experiencing homelessness, and if so, what level of experience do you have?
Select one
No
Yes - with no experience, but willing to be trained
Yes - with little experience
Yes - with some experience
Yes - with a lot of experience
* Would you be willing to mentor a youth with mental health needs, and if so, what level of experience do you have?
Select one
No
Yes - with no experience, but willing to be trained
Yes - with little experience
Yes - with some experience
Yes - with a lot of experience
Group Affiliation
Choose a group
1 Girl
100 Black Men
100 Black Women
5th/3rd
5th3rd African American Network
5th3rd In Action (IA)
A.R.C.S.
ACE
African Professionals Network
Allen Temple Church
Assistance League
Association of Architects
Barron, Peck, Bennie & Schlemmer Law
Be the Change
Belcan
BridgetownChurch
BrownMackieCollege
Catholic Health Partners
Catholic Inner City Schools
CCHMC Childrens Hospital
Central Parkway Church
Children of Choice
Cinci Bar Association
Cinci Init Reduce Violence
Cincinnati Bell
Cincinnati Developmental Institute Inc.
Cincinnati Police Department
Cincinnati Squash Academy
Cincinnati State College Mentor
Healthcare Exploratory Learning Program
Cincinnatus Group
Cincy After School Tutoring
CincyUSAChamber
Cinfed
CITI Camp
Covedale Cares
Crossroads Church
CYC Board Members
Delta Sigma Theta Sorority
Dinsmore Shohl
Dunlap Scholars
Each One Reach One
Ed Cmte YPKC
EmpowerMedia
Entrepreneur
Ernst & Young/ Xavier
Fidelity Mutual/Boys & Girls Club
First Christian Assembly of God
Friendship Ministry
FrostBrownTodd
GE
GE Aviation
GE Manufacturing
Girls to Women
Grace House
Grad Cincinnati
Gray Roads Church
Great American Insurance
Greater Community Church
H.E.L.P.
Hewlett-Packard
Hispanic Network Mentoring
Hughes Engineering Pathway
Hughes UC IT
Hybro System
Hyde Park Community United Methodist Church
Inspirational
Intern
Kroger OGT
Luxottica
M.A.C.C.
M.O.R.E.
M.U. Teach
Manifested Glory Ministries
Mayfield Clinic
Mayor's Inititative
Mengs Martial Arts
MENtor
Mentoring for Success
Mercy Health Partners
Messer Construction
Mirror Movement
MSD Interns
MSD PenPals
Mt. St. Joe
Mt. Washington Presbyterian Church
Nat. Black MBA
Nat.Assoc.Blk.Accountants
New Prospect Church
NewVisionChurch
NHSMBA
None
Northside Community
P&G FAAN
P&G Latinovation 3/16
P&G Pleasant Hill Group
P&G Seed Program
Parkside
PatientPoint (YEP - Youth Engagement Program)
Peoples Church East
PlanteMoran
Queen City Church
Radio One
Rhodia Inc.
Rising Leaders
RJE
S C Ministry
S. Baptist Church
S.U.C.C.E.S.S.
SABER
Saturday Hoops
Sentinels
South Avondale Special Tutors Spring 2010
Star Mentoring Program
SW Ohio Cares Circle
Taft Law
Talbert House
Thomas Moore College
Truepoint
UBS Group
UC Alpha Kappa Psi
UC Bearcat Buddies
UC Biz Mentors
UC College Mentors (Evanston Aca.)
UC IT Early College Program
UC Law
UC Medical Students
UC Scholars
UC SigPhiEps
UC Track Tutors
UCBA College Mentors
UnitedWay
UPS
Urban League
Urban Young Life
US BANK
Villedge
Vineyard Westside
Volunteer Match
Vorys
Western & Southern
Western Southern Life Mentors
WestHillChurch
WHHS Alumni
Whiz Kids
Withrow Alumni Group
Wizkids - City Gospel
Xavier
Xavier Group Gary Favors
Xavier Service Fellows
Young Life
Young Professionals
Young Sisters Empowerment
Youth, Inc
ZooMates
Volunteer Positions
CYC has a number of different volunteer opportunities. For more information on the various different positions that are available click here .
* Position:
Choose a volunteer position
One-To-One Mentoring
Academic Mentor
Group Mentor
Career Mentor
Girls Club
Speakers Bureau
References
Character Reference
* Name:
* Relationship:
* Email Address:
* Phone Number:Example: 5133635200
Character Reference
* Name:
* Relationship:
* Email Address:
* Phone Number:Example: 5133635200
Character Reference
* Name:
* Relationship:
* Email Address:
* Phone Number:Example: 5133635200
For the safety of the students, normal employment verification such as contacting references and police checks will occur.
How did you hear about CYC?
*
Word of mouth TV Radio Internet Newspaper Poster/Flyer Place of Employment CYC Presentation Be the Change CLC Website Other
If other:
Statement of Commitment
As a volunteer working with Cincinnati Students, I agree to:
Attend orientation and training sessions that help me as a volunteer Contact my mentee weekly and see him/her on a regular basis (Mentors Only) Provide up-to-date copies of my driver's license and car insurance (Mentors Only) Abide by all school rules, CYC and Board of Education policies By clicking on the submit button you are agreeing to the statement of commitment and authorizing CYC to add you to their mailing list and contact you by either mail, phone and/or email.
The form make take up to a minute to be processed. Please only click the Submit button once.
* denotes required field