Community Ministries Mentor Application
New Life Ranch • 160 New Life Ranch Dr. • Colcord, OK 74338
Please fill out and return to New Life Ranch – Community Ministries
If you have any questions contact Community Ministries at 918-422-5506 or [email protected]
Personal Information
Name: ___________________________________________________ Birth Date: _____/_____/_____
SS Number: ________-_____-___________ Male Female Race: ____________________________
Marital Status ___________________ Children __________________________________________
Permanent Address:
Street/Box __________________________________________________________________________
City ___________________________ County _____________ State ______ Zip ____________
Email Address __________________________________
Phone (H)______________________ (W)______________________ (Cell)______________________
Which Number are you most easily reached at? Home Work Cell
When is the best time(s) to contact you? ___________________________________________________
Education: High School College Grad Master’s Degree Doctorate
If a student, please furnish the following information:
School Name ___________________________ School Address _____________________________
City __________________________________________ State _______ Zip _________________
School Email Address __________________________ School Phone # (_____)_________________
Date through which address is good ____________________ Date summer begins ______________
In case of emergency, notify ___________________________ Phone # (_____)_________________
Employment Information
Name of Employer _______________________________ Position/Title _______________________
Address ___________________________________________ Phone # (_____)_________________
City __________________________________________ State _______ Zip _________________
Job Description ______________________________________________________________________
___________________________________________________________________________________
Involvement Background and Preferences
Age of youth you would prefer to mentor: Elementary Middle School High School
Would you be able to provide transportation for students? Yes No
(If yes, please complete the transportation form attached and return to NLR.)
Have you been involved in youth work before: (if yes, please describe):
Have you been involved in a mentoring program of any kind before? (if yes, please describe):
Personal Background and Information
Have you ever been convicted of, or pleaded guilty to a misdemeanor or felony crime? Yes No
If yes, please explain __________________________________________________________________
Is there anything now or in the past which would hinder your work with youth at NLR? Yes No
If yes, please explain __________________________________________________________________
Are you presently involved in any of the following behaviors that would necessarily exclude you from
serving as a mentor in this ministry?
Alcohol or drug use: Yes No
Homosexuality: Yes No
Sexual relationship with someone other than your husband or wife: Yes No
Briefly describe your family background:
Who were some of the most significant adults in your life when you were growing up?
Why would you like to be a mentor?
Christian Experience
What church do you presently attend? __________________ How often do you attend? _____________
Please share your spiritual autobiography, explaining the dates and circumstances under which you
became a Christian:
Give your testimony of your relationship with Jesus Christ:
If a student asked you how to become a Christian, what would you say?
What are your beliefs about the age at which a child can become a Christian (i.e. understand the Gospel
and place his faith and trust in Christ?
References
Please provide the names and contact information of 3 adults who are not relatives and who know you
well. At least one reference should come from a Pastor/Sunday School Teacher or Spiritual Leader. We need all
3 references before you can start mentoring. Please email the link http://newliferanch.com/references/ to your
references
Pastor/Sunday School Teacher/Spiritual Leader:
Name _____________________________ Position __________________ Phone _________________
Address ______________________________ City _________________ State ______ Zip __________
Other Reference:
Name _____________________________ Position __________________ Phone _________________
Address ______________________________ City _________________ State ______ Zip __________
Other Reference:
Name _____________________________ Position __________________ Phone _________________
Address ______________________________ City _________________ State ______ Zip __________
I give New Life Ranch permission to contact the above references
Applicant’s Signature __________________________________________ Date _________________
Verification
I hereby authorize New Life Ranch (NLR) and its representatives to engage in background checks regarding
any and all statements I have made on this application and, further, to obtain any other information regarding
my employment, my veracity, my skills and/or abilities which NLR may deem relevant.
I authorize any reference listed in this application to give you any information (including opinions) that he/she
may have regarding my aptitude for pre-adolescent or youth work. In consideration of the receipt and evaluation
of this application by NLR, I hereby release any reference from any and all liability for damages of whatever
kind of nature which may at any time result to me, my heirs, or family, on account of compliance, or any attempts to comply, with this authorization. I waive any rights I may have to inspect any information provided by
me by any reference in this application.
I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE
CONTENTS THEREOF AND SIGN THIS RELEASE AS MY OWN FREE ACT.
Applicant’s Signature _________________________________________ Date __________________
New Life Ranch Articles of Faith (All Mentors must be in agreement!)
New Life Ranch is concerned about the eternal welfare of those who are on the grounds, and their commitment to Jesus Christ.
Therefore, upon signing of the contract, your group agrees to conduct a program that integrates the Bible, and should be in harmony
with the following beliefs:
•
•
•
•
•
•
•
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A belief in the scriptures of the Old and New Testaments as the inspired Word of God and inerrant in the original writing, and
that they are the supreme and final authority in faith and life. II Timothy 3:16, 17; II Peter 1:20, 21; Matthew 5:18; John 16:12-13
A belief in one God eternally existing in three persons: Father, Son, and Holy Spirit. Deuteronomy 6:4; II Corinthians 13:14
A belief that Jesus Christ was begotten of the Holy Spirit and born of Mary, a virgin and a descendant of David. John 1:1-2, 14;
Luke 1:35
A belief that man was created in the image of God; that he sinned and thereby incurred not only physical death but also that
spiritual death which is separation from fellowship with God; that all human beings are born with a sinful nature. Genesis 1:26,
27; Romans 3:22, 23; Romans 5:12; Ephesians 2:1-3, 12
A belief that the Lord Jesus Christ died for our sins according to the scriptures as our representative and substitutionary sacrifice,
and that all who believe in Him and accept Him are justified on the grounds of His shed blood. Romans 3:24, 25; I Peter 2:24;
Ephesians 1:7; I Corinthians 15: 1-3
A belief in the resurrection of the crucified body of our Lord and His ascension into Heaven, and that He is there at the right
hand of God as our High Priest and Advocate. Acts 1:9,10; Hebrews 9:24; Hebrews 7:25; Romans 8:35; I John 2:1-2; I Peter 1;35
A belief in that blessed hope - the personal and imminent return of our Lord and Savior Jesus Christ, and that He will set up His
Kingdom on earth. I Thessalonians 4:13-18; Revelation 19:11-21
A belief that all those who in faith accept the Lord Jesus Christ are born again of the Holy Spirit and thereby become children
of God. John 16:8-11; II Corinthians 3:6; I Corinthians 12:12-14; Romans 8:9; Ephesians 1:13,14; John 16:13; I John 2:20,27;
Ephesians 5:18
A belief in the bodily resurrection of the just and unjust; the everlasting blessedness of the saved and the everlasting punishment
of the lost. Matthew 25:46; John 5:28,29; John 11:25-26; Revelation 20:5,6,12,13; Luke 23:43; Philippians 1:23; Philippians 3:21;
I Thessalonians 4:16-17
I am in agreement with the New Life Ranch Articles of Faith:
Signature ____________________________________________________ Date __________________
Community Ministries Transportation Team Application
New Life Ranch • 160 New Life Ranch Dr. • Colcord, OK 74338
Driving your student to and from New Life Ranch is a great time to connect with your student. It is not
required that you drive, but if you are willing please fill out this Transportation Team Application as well as the
Application for the Appoved Driver’s List.
Driving Information
Type of Vehicle _________________________________________ Number of Seat Belts _________
Please attach a copy of your driver’s license and your auto insurance.
Transportation Policies
1. All passengers must have their own seat belt and remain buckled in the entire time the vehicle is moving.
2. Only drop off participants at their assigned spots. Don’t drop off participants at friend’s or relative’s
houses unless you have the verbal permission of a parent.
3. Children under the age of 4 must be in appropriate car seats that are securely attached.
4. Make sure you load and unload passengers in a safe area where there is no heavy traffic. Continually
observe the traffic and keep the area safe.
5. In case of an accident, first call 911 and then contact the NLR office at 918-422-5506.
6. There are many things that can happen while driving. Please stay alert and do your best.
Community Ministries Transportation Team Application
New Life Ranch • 160 New Life Ranch Dr. • Colcord, OK 74338
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