Mentor Application | Probate / Juvenile Court

Welcome to the Clermont County Probate/Juvenile web site. It is my pleasure to provide this gateway to the Probate/Juvenile Court. This site will provide the users with access to Probate case information, necessary forms for Probate matters and information regarding the procedures and practices at the Probate and Juvenile Court.

Judge James A. Shriver

eFiling Juvenile Court

Public Case Access Probate Court

Attorney Case Access Probate Court

Clermont County Probate Court provides remote access to its court records subject to the exclusions as stated in SUP.R.44 (C) (2) and (G) (2); and as provided in SUP.R. 45 (C) the Court has excluded electronic images of all case documents in all case types. These documents are available through direct access of the court record at the Probate Court.

Mentor Application

Name *

First

Last

DOB *

Phone Number *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Driver's License Number *

Employer

Occupation

Work Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Phone

Please list addresses where you have lived for the last five (5) years. Begin with your current address.

Date From: *

Date To: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date From:

Date To:

Address 2

Address Line 1

Address Line 2

City

State

Zip Code

Date From:

Date To:

Address 3

Address Line 1

Address Line 2

City

State

Zip Code

Please provide two (2) personal references (non-family members)

Reference 1 *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Reference 2 *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Please provide your last three (3) places of employment

Company 1 *

Title

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date From:

Date To:

Company 2

Title

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date From:

Date To:

Company 3

Title

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date From:

Date To:

Is there a day of the week that you will be unable to meet with your mentee? Please List Days. (N/A for No)

Please write a brief statement as to why you want to be a mentor:

Please describe special hobbies/interests which may be helpful in matching you with a mentee (example, cooking, crafts, career interests, chess, sports, computers, nature, etc.)

Please list any experience(s) you have working with children? How will your experience help you in working with your mentee?

Have you ever previously participated in a mentor role? How would you describe the experience?

Are You 21 years of age or older? *

Do you reside in Clermont County? *

Are you willing to adhere to the program policies and procedures? *

Do you agree to a twelve (12) month commitment? *

Can you commit to a minimum of four (4) hours per month? *

Do you agree to regularly touch base with your mentee? *

Do you agree to attend any required training sessions? *

Are you willing to communicate regularly with the program coordinator? *

Are you willing to submit monthly meeting and activity information? *

Do you have reliable transportation? *

Do you have a current driver’s license and insurance? *

Do you have a good driving record? *

Have you ever been accused, arrested, charged or convicted of child sexual abuse? *

Have you been convicted of a felony within the last seven (7) years? *

Do you use alcohol or controlled substances inappropriately? *

Are you currently in treatment for substance abuse? *

Have you been hospitalized for a mental disorder in the past three (3) years? *

Mentor Interest Survey

Are you a morning person or a night owl?

Type of Music

What is your favorite …

Food

Movie Genre

Book

Game

Hobby

Place to hang out

Sport

Physical Activity

Time of Year

Enter any other descriptions that are not mentioned

Please fill out the Release Statement and upload below before submitting application.
You may also email the release to Susan Stark.

Release Statement Upload

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