Mentee Application

Parent/Guardian
Parent/Guardian Information *

First Name Last Name
Is your Address the same as the applicant's?

Yes No
Parent/Guardian Address

Street Address

Street Address Line 2

City State

Zip Code
Parent/Guardian Phone Number *
Please, provide phone number
Parent/Guardian Email *
example@example.com
Emergency Contact Phone Number *

Use Parent/Guardian's Other Number
Parent Preferred Communication *

Work Phone Text (use cell phone) Cell Phone Email

Interests: Education/Career
What are your post-high school goals? *
(Tell us about your desired career path - for example, pediatrician,programmer, business ownership, etc,)?
If you know the colleges or schools you would like to attend, list them.
Select one or more industries based on your career interests *
Rank your top 3 industries, if you selected more than 3
Have you attended middle school in the U.S? *

Yes No

Applicant Basic Information