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Mentee Questionaire

Please take a moment to fill out the form.

First Name

Last Name

School and/or Year of Graduation

Birthday

Why do you want to be a part of this program?

What do you hope to accomplish while partaking in this program?

Who is someone that you are grateful for in your life? Why?

What areas in your life would you like to improve on?

Thanks for submitting, you'll be hearing from us soon !

Parent/ Gaurdian

Please take a moment to fill out the form.

First Name

Last Name

Email

NOTE: This form will also be used as a permission slip to take your child to age-
appropriate events (e.g., dinner, movie, and concerts). If agree, please sign below.

What topics do you think would be beneficial for your child while partaking in this mentorship program?

Phone Number

Emergency Contact: Name & Number

Students Signature

Parent/Guardian Signature

Thanks for submitting!

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