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6 Cups to College Mentor ProgramNext Steps for New Mentors1. 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 totransport mentees; print, sign, and return hardcopy)d. Request for Live Scan Service form (after completing your Live Scan, please keep a copy of thecompleted 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 RiskAssessment flyer attached for options. NOTE: Please bring a valid photo ID to your Live Scanappointment, and remember to keep a copy of the completed Request for Live Scan Service form toreturn to our office.4. Once we have received your forms, and you have cleared the Live Scan and TB risk assessment, andcompleted the orientation:a. You will be matched with a mentee and notified via email in August/Septemberb. This email will include your mentees contact information, including preferred method ofcommunication, information about his/her college plans, and options for scheduling your firstmeeting (see below)5. The school sites will be hosting Meet & Greet sessions for you and your mentee in an effort toovercome 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 fordates and times)b. At the Meet & Greet you will receive:i. 6 Cups branded Contigo travel mug for youii. 6 Cups branded water bottle for your mentee(s)iii. College / Career Planning URL magnets for bothiv. 6 Cups branded padfolio for you – containing:1. Timelines for 11th & 12th graders2. This is me / This is you – ice breaker activity for the 1st meeting3. CSU checklist6. 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 makealternative arrangements.Tony Boatner, Stanislaus County Office of Education, 1100 H Street, Modesto, CA 95354aboatner@stancoe.org (209) 238-1717

Live Scan & TB Risk AssessmentFor Live Scan services in the Modesto area, please visit one of our agents at:1) UPS Store at 3848 McHenry Ave, Suite 135, Modesto, CA2) Mail Depot at 6333 Oakdale Rd, Suite I, Riverbank, CAPlease take the attached Account Notice and a valid photo ID with you to yourappointment.For TB Risk Assessment, please provide proof of recent TB test (within the pastyear). If you need a TB Risk Assessment, please make an appointment with ournurse, Ann Bonfiglio (209) 404-6961.Please submit documents to Tony Boatner at aboatner@stancoe.org, or fax (209) 238-4242, or mailto my attention at Stanislaus County Office of Education, 1100 H Street, Modesto, CA 95354.

Account NoticeCertifix Live Scan AccountPlease present this flyer when getting fingerprinted to ensure that your live scanis processed at no cost to you.NAME OF ACCOUNTStanislaus County of EducationCERTIFIX ACCOUNT NUMBER35759N 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 FingerprintedVisit a participating Certifix Live Scan location. If you weren’t provided with one,either choose one at certifixlivescan.com (be sure it’s marked "AcceptsAccounts") or contact Certifix Live Scan (see below) for assistance.What to BringTo get fingerprinted, bring physical copies of the following items with you to thelocation: Request for Live Scan Service FormComplete the Applicant Information section, and bring 2 or 3 copies asneeded. Valid 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 alerts the location to process your live scan at no cost to you.Questions?If you have any questions, comments, or are asked to pay the location, pleasecontact Certifix Live Scan.(800) 710-1934support@certifixlivescan.com

STATE OF CALIFORNIABCIA 8016(orig. 04/2001; rev. 01/2011)DEPARTMENT OF JUSTICEREQUEST FOR LIVE SCAN SERVICEApplicant SubmissionA1138VOLUNTEERORI (Code assigned by DOJ)Authorized Applicant Type6 CUPS TO COLLEGE VOLUNTEERType of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)Contributing Agency Information:Stanislaus County Office Of Education02066Agency Authorized to Receive Criminal Record InformationMail Code (five-digit code assigned by DOJ)1100 H StreetKandy WoerzStreet Address or P.O. BoxContact Name (mandatory for all school submissions)ModestoCA95354(209) 238-1733CityStateZIP CodeContact Telephone NumberApplicant Information:Last NameFirst NameOther Name(AKA or Alias) LastFirstSexDate of BirthHeightWeightMaleEye ColorFemaleHair ColorMiddle InitialSuffixDriver's License NumberBillingNumber(Agency Billing Number)Place of Birth (State or Country)Social Security NumberMisc.Number(Other Identification Number)HomeAddressStreet Address or P.O. BoxCityStateLevel of Service:Your Number:DOJZIP CodeFBIOCA Number (Agency Identifying Number)If re-submission, list original ATI number:(Must provide proof of rejection)Original ATI NumberEmployer (Additional response for agencies specified by statute):Employer NameMail Code (five digit code assigned by DOJ)Street Address or P.O. BoxCityStateZIP CodeTelephone Number (optional)Live Scan Transaction Completed By:Name of OperatorDateTransmitting AgencyLSIDORIGINAL - Live Scan OperatorATI NumberSECOND COPY - ApplicantSuffixAmount Collected/BilledTHIRD COPY (if needed) - Requesting Agency

Acceptable Forms of IDState-issued driver’s license or State-issued IDU.S. Passport or U.S. Passport CardFederal Government Personal Identity Verification Card (PIV)Uniformed Services Identification CardDepartment of Defense Common Access CardForeign 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 photographU.S. Coast Guard Merchant Mariner CardCanadian driver’s licenseHowever, in the absence of a primary form of identification, applicants may provide atleast 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 DocumentsWhen validating the authenticity of secondary identification documents and forms, thedata 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

Live Scan & TB Risk AssessmentFor Live Scan services in the Modesto area, please visit one of our agents at:1) UPS Store at 3848 McHenry Ave, Suite 135, Modesto, CA2) Mail Depot at 6333 Oakdale Rd, Suite I, Riverbank, CAPlease take the attached Account Notice and a valid photo ID with you to yourappointment.For TB Risk Assessment, please provide proof of recent TB test (within the past year).If you need a TB Risk Assessment, please contact our nurse, Ann Bonfiglio, via textor email at (209) 404-6961, abonfiglio@stancoe.org.Please submit documents to Tony Boatner at aboatner@stancoe.org, or fax (209) 238-4242, or mailto my attention at Stanislaus County Office of Education, 1100 H Street, Modesto, CA 95354.

Account NoticeCertifix Live Scan AccountPlease present this flyer when getting fingerprinted to ensure that your live scanis processed at no cost to you.NAME OF ACCOUNTStanislaus County of EducationCERTIFIX ACCOUNT NUMBER35759N 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 FingerprintedVisit a participating Certifix Live Scan location. If you weren’t provided with one,either choose one at certifixlivescan.com (be sure it’s marked "AcceptsAccounts") or contact Certifix Live Scan (see below) for assistance.What to BringTo get fingerprinted, bring physical copies of the following items with you to thelocation: Request for Live Scan Service FormComplete the Applicant Information section, and bring 2 or 3 copies asneeded. Valid 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 alerts the location to process your live scan at no cost to you.Questions?If you have any questions, comments, or are asked to pay the location, pleasecontact Certifix Live Scan.(800) 710-1934support@certifixlivescan.com

STATE OF CALIFORNIABCIA 8016(orig. 04/2001; rev. 01/2011)DEPARTMENT OF JUSTICEREQUEST FOR LIVE SCAN SERVICEApplicant SubmissionA1138VOLUNTEERORI (Code assigned by DOJ)Authorized Applicant Type6 CUPS TO COLLEGE VOLUNTEERType of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)Contributing Agency Information:Stanislaus County Office Of Education02066Agency Authorized to Receive Criminal Record InformationMail Code (five-digit code assigned by DOJ)1100 H StreetKandy WoerzStreet Address or P.O. BoxContact Name (mandatory for all school submissions)ModestoCA95354(209) 238-1733CityStateZIP CodeContact Telephone NumberApplicant Information:Last NameFirst NameOther Name(AKA or Alias) LastFirstSexDate of BirthHeightWeightMaleEye ColorFemaleHair ColorMiddle InitialSuffixDriver's License NumberBillingNumber(Agency Billing Number)Place of Birth (State or Country)Social Security NumberMisc.Number(Other Identification Number)HomeAddressStreet Address or P.O. BoxCityStateLevel of Service:Your Number:DOJZIP CodeFBIOCA Number (Agency Identifying Number)If re-submission, list original ATI number:(Must provide proof of rejection)Original ATI NumberEmployer (Additional response for agencies specified by statute):Employer NameMail Code (five digit code assigned by DOJ)Street Address or P.O. BoxCityStateZIP CodeTelephone Number (optional)Live Scan Transaction Completed By:Name of OperatorDateTransmitting AgencyLSIDORIGINAL - Live Scan OperatorATI NumberSECOND COPY - ApplicantSuffixAmount Collected/BilledTHIRD COPY (if needed) - Requesting Agency