6 Cups to College Mentor Program Next Steps for New Mentors

1. Please complete the program orientation (see attached flyer for dates/times or online option.)

2. Complete the following forms (available on our website at www.stancoe.org/6Cups): a. Participation Form for New Mentors (complete and submit electronic form) b. Volunteer Application form (print, complete both sides, and return hardcopy) c. Volunteer Personal Vehicle Use Form (optional, but highly recommended, for those wanting to

transport mentees; print, sign, and return hardcopy) d. Request for Live Scan Service form (after completing your Live Scan, please keep a copy of the

completed Request for Live Scan Service form, return it to our office via email or hardcopy)

3. Complete a Dept. of Justice Live Scan and TB Risk Assessment. Refer to the Live Scan and TB Risk Assessment flyer attached for options. NOTE: Please bring a valid photo ID to your Live Scan appointment, and remember to keep a copy of the completed Request for Live Scan Service form to return to our office.

4. Once we have received your forms, and you have cleared the Live Scan and TB risk assessment, and completed the orientation:

a. You will be matched with a mentee and notified via email in August/September b. This email will include your mentees contact information, including preferred method of

communication, information about his/her college plans, and options for scheduling your first meeting (see below)

5. The school sites will be hosting Meet & Greet sessions for you and your mentee in an effort to overcome some of the awkwardness or concern that students may have about meeting a stranger.

a. RSVP for the Meet & Greet session that you would like to attend (see mentee info email for dates and times)

b. At the Meet & Greet you will receive: i. 6 Cups branded Contigo travel mug for you

ii. 6 Cups branded water bottle for your mentee(s) iii. College / Career Planning URL magnets for both iv. 6 Cups branded padfolio for you – containing:

1. Timelines for 11th & 12th graders 2. This is me / This is you – ice breaker activity for the 1st meeting 3. CSU checklist

6. Be prepared to schedule your next meeting with the student before the conclusion of the Meet &

Greet. If you are unable to attend a Meet & Greet session, please contact our office to make alternative arrangements.

Tony Boatner, Stanislaus County Office of Education, 1100 H Street, Modesto, CA 95354

aboatner@stancoe.org | (209) 238-1717

For Live Scan services in the Modesto area, please visit one of our agents at:

1) UPS Store at 3848 McHenry Ave, Suite 135, Modesto, CA

2) Mail Depot at 6333 Oakdale Rd, Suite I, Riverbank, CA

Please take the attached Account Notice and a valid photo ID with you to your appointment.

For TB Risk Assessment, please provide proof of recent TB test (within the past year). If you need a TB Risk Assessment, please make an appointment with our nurse, Ann Bonfiglio (209) 404-6961.

Live Scan & TB Risk Assessment

Please submit documents to Tony Boatner at aboatner@stancoe.org, or fax (209) 238-4242, or mail to my attention at Stanislaus County Office of Education, 1100 H Street, Modesto, CA 95354.

Please present this flyer when getting fingerprinted to ensure that your live scanis processed at no cost to you.

N A M E O F A C C O U N TN A M E O F A C C O U N T

Stanislaus County of EducationStanislaus County of Education

C E R T I F I X A C C O U N T N U M B E RC E R T I F I X A C C O U N T N U M B E R

3575935759

N O T E T O L O C AT I O NN O T E T O L O C AT I O NIf a Billing Number is provided on the Request for LiveScan Service form, please also apply it to the transaction.

Where to Get FingerprintedWhere to Get Fingerprinted

Visit a participating Certifix Live Scan location. If you weren’t provided with one,either choose one at certifixlivescan.com certifixlivescan.com (be sure it’s marked "AcceptsAccounts") or contact Certifix Live Scan (see below) for assistance.

What to BringWhat to Bring

To get fingerprinted, bring physical copies of the following items with you to thelocation:

Request for Live Scan Service FormRequest for Live Scan Service FormComplete the Applicant Information section, and bring 2 or 3 copies asneeded.

Valid Photo IDValid Photo IDA current, state-issued driver license or ID card is sufficient. If this isunavailable, contact Certifix Live Scan (see below) to find out what youneed.

This Account Notice FlyerThis Account Notice FlyerThis alerts the location to process your live scan at no cost to you.

Questions?Questions?

If you have any questions, comments, or are asked to pay the location, pleasecontact Certifix Live Scan.

(800) 710-1934 support@certifixlivescan.com

Account NoticeAccount NoticeCertifix Live Scan AccountCertifix Live Scan Account

STATE OF CALIFORNIA DEPARTMENT OF JUSTICEBCIA 8016 (orig. 04/2001; rev. 01/2011)

REQUEST FOR LIVE SCAN SERVICE

Applicant Submission

ORI (Code assigned by DOJ) Authorized Applicant Type

Type of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)

Contributing Agency Information:

Agency Authorized to Receive Criminal Record Information Mail Code (five-digit code assigned by DOJ)

Street Address or P.O. Box

City State ZIP Code

Contact Name (mandatory for all school submissions)

Contact Telephone Number

Applicant Information:

Last Name First Name Middle Initial Suffix

Other Name (AKA or Alias) Last First Suffix

Date of Birth Sex Male Female Driver's License Number

Height Weight Eye Color Hair Color

Place of Birth (State or Country) Social Security Number

Home Address Street Address or P.O. Box City State ZIP Code

Billing Number

(Agency Billing Number)Misc. Number

(Other Identification Number)

Your Number:OCA Number (Agency Identifying Number)

Level of Service: DOJ FBI

If re-submission, list original ATI number: (Must provide proof of rejection)

Original ATI Number

Employer (Additional response for agencies specified by statute):

Employer Name

Street Address or P.O. Box

City State ZIP Code

Mail Code (five digit code assigned by DOJ)

Telephone Number (optional)

Live Scan Transaction Completed By:

Name of Operator Date

Transmitting Agency LSID ATI Number Amount Collected/Billed

ORIGINAL - Live Scan Operator SECOND COPY - Applicant THIRD COPY (if needed) - Requesting Agency

A1138 VOLUNTEER

6 CUPS TO COLLEGE VOLUNTEER

Stanislaus County Office Of Education 02066

1100 H Street

Modesto CA 95354

Kandy Woerz

(209) 238-1733

Acceptable Forms of ID ● State-issued driver’s license or State-issued ID ● U.S. Passport or U.S. Passport Card ● Federal Government Personal Identity Verification Card (PIV) ● Uniformed Services Identification Card ● Department of Defense Common Access Card ● Foreign Passport with Appropriate Immigration Document(s) ● USCIS-Permanent Resident Card (I-55I) ● USCIS-Employment Authorization Card (I-766) ● Federal,state,or local government agency ID card with photograph ● U.S. Coast Guard Merchant Mariner Card ● Canadian driver’s license

However, in the absence of a primary form of identification, applicants may provide at least 2 secondary identification documents including:

● State Government Issued Certificate of Birth ● U.S. Tribal or Bureau of Indian Affairs Identification Card ● Native American tribal document ● Social Security Card ● Court Order for Name Change/Gender Change/Adoption/Divorce ● Marriage Certificate (Government Certificate Issued) ● Draft Record ● School ID with photograph ● Certificate of Citizenship (N-560) ● Replacement Certificate of Citizenship (N-561) ● Certificate of Naturalization (N550) ● Replacement Certificate of Naturalization (N-570)

Secondary Identification Data Support Documents When validating the authenticity of secondary identification documents and forms, the data and information may be supported by at least two of the following current documents:

● Utility Bill (Address) ● Jurisdictional Voter Registration Card ● Vehicle Registration Card/Title ● Paycheck Stub with Name/Address ● Jurisdictional Public Assistance Card ● Spouse/Parent Affidavit