Alateen Sponsorship

Alateen is for young people whose lives have been affected by someone else’s drinking. Alateen groups need members of Al-Anon to serve as Sponsors.

Sponsorship Form

This form is for collecting information from Alateen sponsor applicants and will ensure that both parties are clear on the expectations of sponsorship if the application is accepted.

First Name:

Middle Name:

Last Name:

Date of Birth:

Home Phone:

Cell Phone:

Other:

Email Address:

Have you used any other names in the past seven years? YesNo

First Name:

Middle:

Last Name:

From:

To:

Please list all addresses of residence/employment for the past seven years:

Street Address:

Zip Code:

Country:

State:

City:

From:

To:

Current address:
YesNo

Add another address?

Employer Name:

Address:

Zip Code:

Country:

State:

City:

From:

To:

Current employer:
YesNo

Add another employer

Do you have a valid driver's license?
YesNo

State:

License #:

Expires:

Have you been an active member of Al-Anon for at least two years, not including time in Alateen, and are you actively working with an Al-Anon sponsor:
YesNo

Have you ever been convicted of a felony, or charged with child abuse or any other inappropriate sexual or violent behavior, or demonstrated emotional problems which could result in harm to Alateen members?
YesNo

What Alateen Group(s) do you plan to sponsor (regular or substitute)?

What is your current Al-Anon home group(s)?

What district is your group a part of?

Please provide the name and contact information for two Al-Anon members who can speak to your commitment to Al-Anon Twelve Step recovery and their support for you as an Alateen sponsor. We require that one be your Al-Anon sponsor. Family members and current MN South Area Alateen Safety Committee members may not be used as a reference. Please alert your references that they will receive a brief phone call regarding your AMIAS application.

Voucher 1 First Name:

Voucher 1 Last Name:

Voucher 1 Phone:

Voucher 1 Email Address:

Voucher 2 First Name:

Voucher 2 Last Name:

Voucher 2 Phone:

Voucher 2 Email Address:

Have you ever been convicted of a misdemeanor or a felony?
YesNo

Date:

Offense:

Country:

State:

City:

Add more

The above information is true and correct.

I grant Minnesota South Area AlAnon/Alateen and their agents or Trusted Servants, their assigned background screening agency, and their agents permission to perform an investigation into my background.

If accepted as a volunteer with Minnesota South Area Alateen, this authorization is valid for the duration of my service.

I attest that all of the above information is true and accurate and hereby grant permission to contact the above-named Al-Anon members.

I've read and agree to abide by the Minnesota South Area Alateen Safety & Behavioral Requirements & all applicable laws.

I give permission to access any other records deemed necessary to assess my character and fitness for service.

I authorize all persons, schools, companies, corporations, state agencies, federal agencies, court systems, and law enforcement agencies to release such information without restriction or qualification to Minnesota South Area Al-Anon and its background screening agency.

I hereby release Minnesota South Area Al-Anon, it's agents & Trusted Servants, any assigned background screening agency, and their agents from any and all liability arising from the preparation of this report or investigation relating thereto. I understand that I won't incur any cost related to this background check process.

I agree that failure to reveal any requested information, or providing any false or misleading information on this form or any application form, may be grounds for refusal to enlist my services and negate any present or future volunteer possibilities with Minnesota South Area Alateen.

I also understand that the results of this background check may disqualify me from volunteering for Minnesota South Area Alateen.

I agree that this release is valid for the duration of my service and that Minnesota South Area Al-Anon or its background screening agency (at the request of Minnesota South Area Al-Anon) may choose to investigate my background at any time during the term of my service.

I have a right to a copy of the results of the background check conducted and the right to challenge any background screening agency and their sources regarding any incorrect information it contains.

I may also request a copy of my records from the Minnesota Bureau of Criminal Apprehension.

I have read and understand the terms of this authorization and agree to the terms stated herein. A photocopy or facsimile of this authorization will be treated the same as an original.

I am in compliance with my area's safety and behavioral requirements and agree to abide by them.