CLIC Mentoring Application
The CLIC Mentoring Program provides personalized mentorship to young boys aged 8-18 from underserved communities. Our program focuses on developing leadership skills, cultural pride, and life skills through workshops, activities, and one-on-one mentoring. By joining, participants will gain valuable guidance to help them achieve academic success, personal growth, and community engagement.This application form is designed to gather important information about prospective mentees to ensure they receive tailored support and are matched with the right mentor. All information provided will remain confidential
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First
Last
Birthdate
Address
City
State
Zip Code
Phone Number
Email Address
School Name
Grade Level
Describe what types of grades the child receives
Does the child have any medical conditions *
Describe any medical conditions
Child's shirt size
List ALL school, church, and community activities
What are your child's aspirations or career goals for the future?
Primary Parent/Guardian
Primary Parent/Guardian's Phone Number
Primary Parent/Guardian's Email Address
Parent/Guardian #2
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Email Address
Please indicated the child's family structure
What is the child's household family income
For more information about CLIC Mentoring Program, please contact Dr. Francis Francois at 786-977-4060 or doc@clicsfl.org
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