Second Chance 360 Juvenile Program

Christ-Led Mentor Application

Serving Court-Ordered Youth Ages 10-16

LOVE • EMPOWER • LIBERATE

The miracle starts with YOU.

The Second Chance 360 Juvenile Program is a Christ-centered youth realignment initiative designed to support court-ordered juveniles ages 10-16 through Saturday workshops, mentoring, accountability, life skills, community service, leadership development, and purpose-building.

Our goal is to help each youth understand that one mistake does not define their future. Through love, structure, faith, and guidance, we help young people rebuild identity, responsibility, confidence, discipline, and purpose.

Before serving with youth, all mentors must:

1. Complete the mandatory background check
2. Pay the required background check processing fee (approximately $28-$30, mentor applicant’s responsibility)
3. Complete the free child safety training video (emailed by Miracles R Real Outreach, Inc. after the background check has been completed)
4. Receive approval from Miracles R Real Outreach, Inc.

Submitting this application does not guarantee mentor approval.

Mentor Application

Please complete all sections of the mentor application below. The form is organized into eleven short steps. You may save your progress and continue later if needed.

1Applicant Info

2Mentor Interest

3Areas of Interest

4Availability

5Background Check

6Child Safety Video

7Safety Screening

8Mentor Expectations

9Faith Reflection

10References

11Agreement

Name

This field is for validation purposes and should be left unchanged.

Full Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Phone Number(Required)

Email Address(Required)

Home Address(Required)

Street address

City, State, ZIP(Required)

Occupation / Employer(Required)

Church / Ministry Affiliation

If applicable

Are you currently involved in youth ministry, mentoring, education, counseling, coaching, or community outreach?(Required)

Yes

If yes, please explain(Required)

Mentor Interest

Help us understand why you want to serve and what you bring to the Second Chance 360 Juvenile Program.

Why are you interested in becoming a mentor with the Second Chance 360 Juvenile Program?(Required)

What does being a Christ-led mentor mean to you?(Required)

What strengths, gifts, or experiences do you believe you can bring to this program?(Required)

Have you ever mentored or worked with youth ages 10-16?(Required)

Yes

If yes, please describe your experience(Required)

Areas of Interest

Please check any areas where you feel comfortable serving or supporting:

Areas of Interest(Required)

Youth mentoring

Bible-based encouragement

Life skills workshops

Leadership development

Conflict resolution

Anger management support

Accountability and decision-making

Job readiness or career exposure

Financial literacy

Hygiene, etiquette, and personal presentation

Community service supervision

Parent/guardian engagement

Administrative support

Guest speaking

Prayer support

Other area of interest (please specify)

Availability

The Second Chance 360 Juvenile Program will primarily operate on Saturdays.

Are you available on Saturdays?(Required)

Yes

Sometimes

Preferred Saturday availability(Required)

Morning

Afternoon

Full day

As needed

Check all that apply

How often are you able to serve?(Required)

Weekly

Twice per month

Once per month

Special workshops only

As needed

Are you willing to attend mentor orientation and training before serving with youth?(Required)

Yes

Mandatory Background Check and Processing Fee

Because the Second Chance 360 Juvenile Program serves minors, court-ordered youth, and vulnerable youth populations, all mentors are required to complete and pass a background check before being approved to serve.

Background checks will be processed through a Miracles R Real Outreach-approved background screening provider or a designated partner company selected by Miracles R Real Outreach, Inc.

The background check is mandatory and must be completed before any mentor is allowed to participate in youth activities, workshops, mentoring sessions, transportation, supervision, or direct youth engagement.

The background check processing fee is approximately $28-$30 and is the responsibility of the mentor applicant.

Do you agree to complete the mandatory background check required by Miracles R Real Outreach before serving with any youth?(Required)

Yes

Notice: You cannot proceed to youth service approval without completing the mandatory background check.

Do you understand that the background check is required and mandatory?(Required)

Yes

Do you understand that the background check will be completed through a Miracles R Real Outreach-approved background screening provider or designated partner company?(Required)

Yes

Do you understand that you are responsible for paying the required background check processing fee of approximately $28-$30?(Required)

Yes

Notice: You cannot proceed to approval without the required payment.

Are you willing and able to pay the required background check processing fee before being approved to serve as a mentor?(Required)

Yes

Applicant Initials(Required)

Payment instructions will be provided after submission once Miracles R Real Outreach confirms your approved background screening provider.

Mandatory Child Safety Training Video

Because the Second Chance 360 Juvenile Program serves minors and court-ordered youth, all mentors are required to complete a child safety training video before being approved to serve.

The child safety training video is free of charge and will be sent by Miracles R Real Outreach, Inc. via email after the mentor applicant has completed the required background check process.

This training is mandatory and is designed to help mentors understand appropriate boundaries, youth protection expectations, safety procedures, reporting responsibilities, and professional conduct when working with minors.

Mentors may not participate in youth workshops, mentoring sessions, supervision, transportation, or any direct youth engagement until the required child safety training video has been completed and confirmed by Miracles R Real Outreach, Inc.

Do you understand that the child safety training video is required and mandatory before serving with youth?(Required)

Yes

Notice: You cannot proceed to youth service approval without completing the mandatory child safety training video.

Do you understand that the child safety training video is free and will be emailed by Miracles R Real Outreach after your background check has been completed?(Required)

Yes

Do you agree to complete the required child safety training video before being approved as a mentor?(Required)

Yes

Applicant Initials(Required)

Additional Background and Safety Screening

Have you ever been convicted of a criminal offense, excluding minor traffic violations?(Required)

Yes

If yes, please explain(Required)

Have you ever been accused, investigated, or disciplined for misconduct involving a minor, vulnerable adult, or youth organization?(Required)

Yes

If yes, please explain(Required)

Have you ever been removed from a volunteer, church, school, youth, or nonprofit program?(Required)

Yes

If yes, please explain(Required)

Mentor Expectations

Please initial each statement below to confirm your understanding and agreement.

I understand that Second Chance 360 serves minors and that child safety is a top priority.(Required)

I agree to treat every youth with dignity, respect, patience, and compassion.(Required)

I understand that youth in this program may be court-ordered, but they are not to be judged, shamed, labeled, or mistreated.(Required)

I agree to follow all Miracles R Real Outreach policies, procedures, safety guidelines, and reporting requirements.(Required)

I understand that I am required to complete and pass the mandatory background check before serving with youth.(Required)

I understand that the required background check will be processed through a Miracles R Real Outreach-approved background screening provider or designated partner company.(Required)

I understand that I am responsible for paying the required background check processing fee of approximately $28-$30.(Required)

I understand that I am required to complete the mandatory child safety training video before serving with youth in the Second Chance 360 Juvenile Program.(Required)

I understand that the child safety training video is free of charge and will be emailed to me by Miracles R Real Outreach, Inc. after my background check has been completed.(Required)

I understand that I may not participate in youth workshops, mentoring sessions, supervision, transportation, or any direct youth engagement until all required approvals are completed.(Required)

I understand that I may not be alone privately with a youth without proper authorization and supervision.(Required)

I agree not to exchange personal phone numbers, social media accounts, private messages, or personal contact information with youth unless approved by program leadership.(Required)

I agree not to transport youth in my personal vehicle unless specifically authorized in writing by Miracles R Real Outreach and the youth's parent/guardian.(Required)

I agree to maintain confidentiality regarding youth, families, court-related matters, and program records.(Required)

I understand that if a youth discloses abuse, harm, danger, or a serious safety concern, I must immediately report it to program leadership.(Required)

I agree to model Christ-like character, accountability, integrity, and professionalism while serving.(Required)

Faith and Character Reflection

How do you believe faith can help youth rebuild their identity, discipline, and purpose?(Required)

How would you respond to a youth who is angry, disrespectful, withdrawn, or resistant to guidance?(Required)

What does correction in love mean to you?(Required)

What message would you want every youth in this program to leave with?(Required)

References

Please provide two references who can speak to your character, reliability, and ability to work with youth.

Reference 1

Reference 1 - Name(Required)

Reference 1 - Relationship(Required)

Reference 1 - Phone(Required)

Reference 1 - Email(Required)

Reference 2

Reference 2 - Name(Required)

Reference 2 - Relationship(Required)

Reference 2 - Phone(Required)

Reference 2 - Email(Required)

Emergency Contact

Emergency Contact - Name(Required)

Emergency Contact - Relationship(Required)

Emergency Contact - Phone(Required)

Applicant Agreement

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that submitting this application does not guarantee acceptance as a mentor.

I understand that Miracles R Real Outreach, Inc. reserves the right to approve, deny, delay, or remove mentors based on program needs, screening results, safety concerns, conduct, failure to complete required steps, or failure to follow program policies.

I understand that all background checks must be completed through a Miracles R Real Outreach-approved background screening provider or designated partner company selected by Miracles R Real Outreach, Inc.

I understand that completion and approval of a background check is mandatory before serving as a mentor, and I agree that I am responsible for paying the required background check processing fee of approximately $28-$30.

I understand that completion of the mandatory child safety training video is required before I may serve with youth in the Second Chance 360 Juvenile Program. I understand that the child safety training video is free of charge and will be sent to me by Miracles R Real Outreach, Inc. via email after my background check has been completed.

I understand that failure to complete the mandatory background check, payment requirement, child safety training video, orientation, or any other required approval step may result in denial or delay of my mentor approval.

If selected, I agree to serve with integrity, compassion, consistency, and Christ-centered leadership. I understand that the youth served through the Second Chance 360 Juvenile Program deserve guidance, accountability, encouragement, and protection.

Final Agreement(Required)

I have read and agree to all of the statements above.

Applicant Signature(Required)

Sign with your mouse, finger, or stylus

Date(Required)

MM slash DD slash YYYY

LOVE • EMPOWER • LIBERATE

The miracle starts with YOU.

Questions? Contact Miracles R Real Outreach, Inc. at info@miraclesrreal.org