Mentor Program Forms

The following forms may be downloaded for use by schools as part of the Waterbury Mentor Program for students.  This program matches caring adult volunteers with at-promise students who could benefit from one-to-one adult attention during the school day.  Parent permission is required for a student to participate.  Mentors will be assigned based on several matching characteristics (location, availability, etc).

Parents should receive a copy of the Parent Permission Form to sign and return and a copy of the Parent Guide, which they keep for reference. 

Teachers (or other staff) should fill out a Staff Request Form to request a mentor for a student.  Prior to requesting a mentor, it is suggested that teachers refer to the Teachers Guide for general information about the program.  This should help in making a decision about whether or not the child is a suitable candidate for the program.  

Completed forms should be returned to Nancy Vaughan at 236 Grand Street, Room 341, Waterbury, CT 06702.  Questions?  Call Nancy at 573-6633 or email her at nvaughan@waterbury.k12.ct.us.

Schools - if you know someone who would make a great Mentor, please give him or her a Mentor Volunteer Application to fill out and return to Nancy Vaughan.   There is a spot where the applicant can specify YOUR school.   There is a fingerprint background check required for all mentors unless we can verify they have previously been fingerprinted by employers and that employer is willing to provide a copy.  There is no charge to the volunteer. A fingerprint card will be mailed to the volunteer when an application is received. After being fingerprinted, the card will be returned to Waterbury Public Schools for processing. 

Volunteers: Would you like to be a mentor? It is a very fun and rewarding experience for both you and your "mentee." We usually match at the elementary school level, but we do have some opportunities to work with older students as well, if you prefer. We will work with you to find the right school, grade, day and time that suits your needs. Volunteer application. We do need to fingerprint potential mentors, and right now the background check process seems to be taking 10 to 12 weeks. We apologize for this delay, but we process through the state of Connecticut and have no control over the length of time required. We do wish to encourage you to apply if you are interested.