Mentee Application
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Which program are you registering your child for? *
Mentee's First Name *
Mentee's Last Name *
Parent/Guardian's Full Name *
Primary Home Address *
Parent/Guardian Email Address *
Primary Phone Number 1 (ex. 765-123-4567) *
Emergency Contact Name & Relationship to Student *
Emergency Contact Phone Number  (ex. 765-123-4567) *
Ethnicity *
Preferred language/s *
Student's Grade Level *
Student's School *
Student T-shirt size: *
Required
Has the mentee been involved with the Juvenile Justice System in the last 12 months? *
Can you tell us why your child needs a mentoring program? *
In addition to time and financial commitments, our mentoring programs require an openness to build and expand a family support system. Are there any time constraints for you, and/or barriers to the mentee participating in the mentoring program at least 75% of the time? 
Do you believe in God or in the concept of a higher power?  If so, describe the most useful and empowering aspects of your relationship with God.  If not, what reference point do you use? *
How would you characterize the family's yearly income? *
What's the best time of day to call to set up an interview for you and the prospective youth? *
How did you learn about our program?
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