Mentee Application 2022

  • Thank you so much for being so interested in becoming a mentee with Mentoring Mentors Inc. This mentee experience encourages youth to embody: leadership, integrity, virtues, a passion for serving within the community, the importance of long-lasting positive relationships, and working together.

    First Step: Please complete all questions on the application as best as possible. If you are under the age of 18, your parent must complete the form.

    Second Step: Schedule face to face in-person interview using the following link:

    • https://calendly.com/mentoringmentorsinc/60min

    Third Step: Commit to do better and build relationships.

    Remember, if you try, you'll always win, but if you don't try, you'll always lose.

    This form must be filled out electronically. Handwritten applications will not be accepted.

    ittp://www.Mentoring-Mentors.org

  • Mentee Application

  • 5. Mentee Date of Birth*
     / /
  • 6. Mentee T-Shirt Size*
  • 8. Mentee Sex*
  • 9. Mentee Sexual Orientation*

  • 10. Mentee Ethnicity*
  • 11. Mentee illnesses (Check all that apply)*

  • 13. Mentee has a history of: (Check all that apply)*

  • 14. Would you like your Mentee to receive counseling services*
  • 15. Household Income Level*

  • 16. Household Family Structure*

  • 17. Mentee Interests (Check all that apply)*
  • 19. Mentee Primary Emergency Contact Relationship*

  •  -
  • 23. Mentee Secondary Emergency Contact Relationship*

  •  -

  • 27. * We would like permission to collect the following information from school provider to help assist with supporting student: Report Cards, Grades Discipline Data, PBIS Data, Attendance, Standardized Testing

    Results, IEP and Social & Emotional Screeners.*

  • Mark only one oval.*

  • 30. * If your child is seriously injured is it okay for Mentoring Mentors staff to transport your child to the hospital? *

  • Mark only one oval.

  • 31. *I hereby grant Mentoring Mentors permission and the right to use photos/ photographs and video recording of my child on Mentoring Mentors website, publications, and promotional materials. *

  • Mark only one oval.*
  • 32. Do we have parent permission to collect grades from mentee
  • Date
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  • Should be Empty: