Girls SySTEM Mentee Application 2020-2021: Kingston

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Thank you for your interest in the Girls SySTEM Mentorship Program! Please complete this form for our Mentorship Program, there are two sections of the application. We will be in touch with you shortly!

For any inquiries or concerns, contact Gabriella.S (Kingston Chapter Lead) at gsmcontact.mentorship@gmail.com

First and Last Name *

Email Address *

Phone Number *

What school do you go to? *

Parent/ Guardian Name *

Parent/ Guardian Email Address *

Parent/ Guardian Phone Number *

City/Location *

I acknowledge that this program is local to Kingston, Ontario

Required

What is the best way for us to contact you? *

Your Email

Your Phone

Parent/Guardian Email

Parent/Guardian Phone

Required

How did you hear about the program? *

Facebook

Instagram

Monthly Newsletter

Twitter

School

Website

A friend (if it was a friend referral, please state their name below)

Other:

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