Center for Civic Engagement and Leadership
Please Note: By completing this application, you are committing yourself to the SLU Buddies program for at least two (2) consecutive semesters. This commitment allows greater relationship building and consistency with your buddy.
Name: Class Year:
Date of Birth: Male/Female:
CMR: SLU Phone: Cell:
E-mail :
What days and times are you available? Please select all that apply for greater scheduling flexibility. (There is no buddy visits scheduled for 2:30-3:30 on Wednesday or Friday.)
Monday Times Available Tuesday Times Available Wednesday Times Available Thursday Times Available Friday Times Available
1.) Are you prepared to make a year's commitment to your Canton Buddy?
If NO, please explain why:
2.) What interests you the most about the SLU Buddies Program?
3.) Have you ever mentored a child before?
If YES, please explain in what capacity and where:
4.) To assist in matching you with a child, please select the personality type below that best describes yourself?
"Other" reason:
5.) What aged child would you prefer? Please keep in mind your availability listed above and what school (Middle/Elementary) each time slot accommodates.
6.) Are you willing to work with a "special needs" child (ex. learning and/or physically disabled)?
7.) Are you willing to work with an ill child (child may need to be out of school at times and you might need to make special arrangements to see him/her?
8.) Are you willing to volunteer to drive a University Van for your scheduled visit day?
9.) Are you certified to drive a University Van?
10.) If NO, are you willing to attend a Driver Certification Training class (apprx. 1.5 hours)?
11.) If yes, please select all days and times you are available to attend a Driver Certification Training class:
12.) I have a car and can give a ride to other SLU Buddies:
If yes, enter # of people you can give a ride to:
12.) Please give two SLU references (ex. professor/advisor/employer):
Reference 1: Reference 2:
