Lunch BuddyApplication Use this form to apply for the RUSC Kinship Lunch Buddies program. Step 1 of 3 33% Your Name* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM slash DD slash YYYY Current Age*Place of Birth* Primary Phone Number*Other PhoneIs it okay to text your primary phone number?* Yes No Email* Preferred Method of Communication* Phone Email Text No preference Background CheckFor safety reasons, RUSC Kinship will need a background study conducted (at RUSC Kinship’s expense).Are you willing to comply with the background check request?* Yes No Do you speak another language?* Yes No What language do you speak?* How many years have you lived at the address you provided in Section 1?*Please list your other addresses from the last 10 years.*Do not include your current address. If you have lived at your residence for more than 10 year, please put N/A.Have you ever been a victim of a crime? Yes No Please explain:*Have you ever been convicted of a felony? Yes No Please explain:* Lunch Buddy PreferencesI would like to be a Lunch Buddy at:* Chokio-Alberta Elementary Morris Area Elementary St. Mary's in Morris No preference I can be a substitute Lunch Buddy.* Yes No Volunteer Record*List service clubs, fraternal organizations, and volunteer boards of which you are a member.Are you affiliated with a local church?* Yes No Name of Church* List your past experience with children or youth:*Do you have any physical limitations or concerns that could affect your ability to commit at least 1 year to mentoring a young person?* Yes No Please describe the limitation or concern.*How did you hear about RUSC Kinship Mentoring?RadioFacebookInstagramNewspaperGoogle SearchWord of MouthAn Email I ReceivedParent / Grandparent of a StudentReferral from Current Lunch BuddyFriend / Family Member ReferralEventSpeaker at ChurchSpeaker at Civic GroupConsent* I agree.I understand that misrepresentation of personal information of history could result in termination or non-acceptance in the RUSC Kinship Mentoring program. RUSC Kinship Mentoring does not discriminate for reasons of race, religion, national origin, gender or sexual orientation. Final approval for all matches is given by the parent/guardian of the child.SignatureCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
