Apply To Be A Survivors’ Mentor

Preliminary Application to Become a Mentor

mentor-survivorFor more information about mentoring before filling out this form, please read How To Help Abuse Victims Online – Email Mentoring.

This page offers you the first step in the mentor application process. If you’re accepted based on the information provided on the form below, we will give you a call. At that time, we’ll make arrangements to safely collect your social security number and $15.00 for your background check.

We conduct background checks using USA Criminal Background.

If you do not want to share your social security number with us or pay $15.00 for your background check, then thank you for your interest in mentoring and we hope you will apply at a later date.

What is your first name?(required)

What is your email address?(required)

What is your address?









What is your age?

How long ago did you leave your abusive relationship?
Less than 1 year1 - 3 years3 - 10 years11 years and more

Are you now in contact with your abuser?



If yes, please tell why you maintain contact:

Below you will find two emails from make-believe survivors. They are in the format you will receive them in should you become a mentor. Please read the information and respond to the survivor. Spelling, grammar and clarity count!

Email 1

From: Katie [Katie's email address]

Are you in an abusive relationship right now? No

If yes, for how long?

If you left, how long ago did you leave? 1 - 3 years

Are you the family or friend of an abused person but have not been abused yourself? No

What would you like to talk about during our consultation?

I want to know how to forget and get over my abusive relationship. I can't seem to shake it. I thought I was better because I had a different relationship that was not abusive after I left, but that is over now. It feels like I just broke up with my abusive boyfriend instead of my latest boyfriend! I guess I didn't heal as well as I'd thought. What can I do?

Your reply to Katie:

Email 2
From: Chandy [Chandy's email address]

Are you in an abusive relationship right now? Yes

If yes, for how long? less than a year

If you left, how long ago did you leave?

Are you the family or friend of an abused person but have not been abused yourself? No

What would you like to talk about during our consultation?

Why do I keep getting sucked back in? I've left five times and gone back each time. I've left him again, but the same cycle of returning is happening. Although I've blocked him on Facebook and send his emails directly to the trash, I am weakening. Today I texted him. I told some of my friends that we are through and they are happy for me...I am ashamed to tell them the truth - that I may end up going back again. What is wrong with me? Why can't I stick with it??

Your reply to Chandy:

You will hear from Janet, Kassandra or Kellie very soon. Thank you for taking the first step to becoming a mentor for abuse survivors.

 

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