SOP 107.18-att-1: Mentor Application (R.I.S.E Program)

Division:
Counseling/Risk Reduction
Effective Date:
August 30, 2019
Topic Area:
107 Policy-Counseling/Risk Reduction
PowerDMS:
View on PowerDMS
Length:
320 words

Summary

This form is used to screen and evaluate incarcerated individuals who wish to become mentors in the R.I.S.E Program. Applicants provide information about their background, skills, educational level, and prior mentoring experience, and are evaluated by recommenders on key competencies including communication, integrity, accountability, and leadership. The form helps identify qualified peer mentors who work directly with other offenders in various mentoring capacities.

Key Topics

  • mentor application
  • R.I.S.E Program
  • peer mentoring
  • program facilitation
  • aide mentoring
  • offender mentors
  • mentoring skills
  • mentor evaluation
  • communication skills
  • integrity
  • leadership
  • accountability
  • Pathfinders
  • Lifer's Group
  • specialized mentor programs
  • competency assessment

Full Text

SOP 107.18
Attachment 1

8/30/19
Page 1 of 2
# Mentor Application (R.I.S.E Program)

_The term “Mentor” applies to any detail or activity where you work directly with_

_another offender. This includes Peer, Program/ Facilitation, and Aide Mentoring._

Last Name: ___________________________ First Name: ________________________

GDC #: ________________________________ D.O.B._____________________________

Current Housing Unit: __________________ Current Detail: ______________________

|Race: Circle One|Col2|Col3|Col4|
|---|---|---|---|
|
Asian|African
American|Native
American|
Multiracial
|
|Pacific
Islander|Hispanic/ Latino|White|Other|

1. List 3 areas you are interested in mentoring:

a. ______________________________________________________________________
b. ______________________________________________________________________
c. ______________________________________________________________________

2. What skills do you possess that you feel will make you a good mentor? Please be specific:

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

3. On a scale from 1-10, rate the following skill sets:

a. Communication

b. Integrity

c. Commitment

d. Leadership

4. Highest Educational Level Completed: ______________

5. TPM: _______________ MRD: ____________

6. Have you had prior experience as a mentor? If yes, then explain your duties.

__________________________________________________________________________

Retention Schedule: Upon completion, this form shall be kept in the offender’s record in SCRIBE and a hard copy
shall be placed in the offender’s institutional file.

SOP 107.18
Attachment 1

8/30/19
Page 2 of 2

__________________________________________________________________________
__________________________________________________________________________
7. Why would you be a good candidate for a mentor?

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

8. Have you ever completed the Lifer’s Group? _______________

9. Have you taken Pathfinders? ____________________________

10. Have you participated in a specialized mentor program? ______

If so, which one? ______________________________________

List up to 3 Recommendations:

|Competency|Needs Work|Satisfactory|Excellent|
|---|---|---|---|
|Communication||||
|Integrity||||
|Accountability||||
|Leadership||||
|Comments:|Comments:|Comments:|Comments:|
|||||
|Signature and Title:|Signature and Title:|Signature and Title:|Signature and Title:|

|Competency|Needs Work|Satisfactory|Excellent|
|---|---|---|---|
|Communication||||
|Integrity||||
|Accountability||||
|Leadership||||
|Comments:|Comments:|Comments:|Comments:|
|||||
|Signature and Title:|Signature and Title:|Signature and Title:|Signature and Title:|
|||||

|Competency|Needs Work|Satisfactory|Excellent|
|---|---|---|---|
|Communication||||
|Integrity||||
|Accountability||||
|Leadership||||
|Comments:|Comments:|Comments:|Comments:|
|||||
|Signature and Title:|Signature and Title:|Signature and Title:|Signature and Title:|

Retention Schedule: Upon completion, this form shall be kept in the offender’s record in SCRIBE and a hard copy
shall be placed in the offender’s institutional file.

Attachments (7)

  1. Mentor Application (R.I.S.E Program) (320 words)
  2. Mentor Contract (R.I.S.E Program) (540 words)
  3. Mentor Evaluation (R.I.S.E Program) (192 words)
  4. Interview Checklist (R.I.S.E. Program) (105 words)
  5. Mentor Orientation Checklist (R.I.S.E. Program) (96 words)
  6. Offender Mentor Program - Pathfinders Mentoring Training (Trifold Brochure) (127 words)
  7. R.I.S.E. Program Acceptance Letter (136 words)
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