Mentor Volunteer Application

If you are interested in becoming a mentor, please complete the fields listed below and click "Send Now" at the bottom of the page. If you do not receive a confirmation email within 48 hours confirming the application went through successfully, please contact Mentoring Services at 605-221-2403.

Please also complete the attached release for a criminal background check. Note: Both the application and release forms must be completed in order to apply to become a mentor.

Contact Information

Best Contact Method
Prefer call in
Are you able to mentor for at least one year?
Do you speak any additional languages?
Are you receiving college credit or participating in the program as part of a college course
Have you ever been convicted of a drug charge?
Have you ever been convicted of a criminal offense?
Have you ever been convicted of abuse, neglect, or assault?

School Preference

Mentoring programs are offered in the following schools. Please check your preference.

I am volunteering as a
Sioux Falls Elementary
Sioux Falls Middle
Sioux Falls High
Brandon Valley
Tea Area
West Central
Other communities

Referral Information

How did you hear about LSS Mentoring Services? Check as many as apply and describe below

Matching Information

I prefer to work with a specific age

If volunteering as an in-person mentor, I am available the following days/times during school hours (typically 8-3):


Please list three non-family references. Please provide complete information to expedite your application.

1st Reference

2nd Reference

3rd Reference

Mentor Agreement

Please check yes or no to confirm your understanding of the program guidelines. Thank you for carefully reading before completing.

By checking yes or no, I hereby state that if accepted as a mentor, I agree to abide by the rules and regulations of the school and LSS Mentoring Services. I affirm that:

For All Mentors

The information I have provided in the application may be verified, and I give permission to the school district listed above and Lutheran Social Services of South Dakota to make inquiry of others concerning my suitability to act as a volunteer.
In the course of volunteering as a mentor, I may be dealing with confidential information, and I agree to keep said information in the strictest confidence. This means that I will not discuss my student’s personal problems publicly or with others.
If I need help, I will seek the assistance of the school site coordinator or LSS Mentoring Services. I understand that this confidentiality does not apply to suspicions I may have about abuse, neglect, illegal activity, or suicide.
If these issues arise, I will immediately contact the school or program personnel.
The relationship between the school district and volunteers is an “at will” arrangement, and that it may be terminated at any time without cause by the volunteer, the school district, or Lutheran Social Services.
I agree to attend new mentor training.
I will be a positive role model to my mentee.
I agree to abide by the policies and guidelines of LSS Mentoring Services and the school in which I volunteer. I understand that failure to do so may result in termination of the mentoring relationship.

For Everyday Hero Mentors

I understand that all mentor activities shall take place during the school day, on school grounds, or at school-sponsored events at which school personnel are in attendance.
I will visit with my mentee 30-60 min. per week at school during the school day or at school-sanctioned events through the school year and any subsequent school year that I participate. If I cannot attend, I agree to contact the school in advance.
I am encouraged to contact the school before a scheduled meeting to verify that the student is in attendance unless the school has specifically indicated that they will contact me.
I am willing to commit to one school year in the program and will be asked to renew my participation in subsequent years.

For USucceed Mentors

I understand that I will meet in public locations throughout the community.
I will meet with my student for at least one hour per week or four hours per month throughout the year.
I will participate in an additional training, submit to additional background screening (fingerprinting, auto insurance, etc). I will actively participate and respond in monthly USucceed Mentor Check-Ins.
I am committing to four school years in the program or until my mentee completes high school.
By clicking here, I certify that all the information I have provided in the application above is accurate.

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