SOP_NUMBER: 107.18-att-1
TITLE: Mentor Application (R.I.S.E Program)
DIVISION: Counseling/Risk Reduction
TOPIC_AREA: 107 Policy-Counseling/Risk Reduction
EFFECTIVE_DATE: 2019-08-30
WORD_COUNT: 320
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/555304
URL: https://gps.press/sop-data/107.18-att-1/

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

ATTACHMENTS:
  1. Mentor Application (R.I.S.E Program)
     URL: https://gps.press/sop-data/107.18-att-1/
  2. Mentor Contract (R.I.S.E Program)
     URL: https://gps.press/sop-data/107.18-att-2/
  3. Mentor Evaluation (R.I.S.E Program)
     URL: https://gps.press/sop-data/107.18-att-3/
  4. Interview Checklist (R.I.S.E. Program)
     URL: https://gps.press/sop-data/107.18-att-4/
  5. Mentor Orientation Checklist (R.I.S.E. Program)
     URL: https://gps.press/sop-data/107.18-att-5/
  6. Offender Mentor Program - Pathfinders Mentoring Training (Trifold Brochure)
     URL: https://gps.press/sop-data/107.18-att-6/
  7. R.I.S.E. Program Acceptance Letter
     URL: https://gps.press/sop-data/107.18-att-7/

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FULL TEXT:
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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|
|---|---|---|---|
|<br>Asian|African<br>           American|Native<br>American|<br>Multiracial<br>|
|Pacific<br>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.