Virtuous Steps - Open House / Mentoring Application

Virtuous Steps Girls - Mentoring Application

Virtuous Steps Girls Mentoring Program is a dynamic mentorship program, for girls 11 to 18 years old, that focuses on teaching essential life skills, engaging in bonding activities, and helping participants develop a confident voice and a visionary mindset. Virtuous Steps is open to the public and meets on the 3rd Sunday of every month from 10 AM - 11:30 AM. -- Help spread the word by telling your friends and family about it. **NOTE: Virtuous Steps Girls Mentoring Program is a program administered by Liberty Community Development Corp (www.lcdcorp.og). ** REGISTRATION DEADLINE: October 27, 2024
YOUTH / TEEN INFO
Youth's Name*

First NameLast Name
Youth's email*
Youth's Cell Number*
Please enter your best contact number
Birthdate (MM/DD)*
example: Enter June 24 as 06/24
Youth's Age*
Select current age
Name of School Youth Attends*
Current Grade*
Select current grade as or Sept. 2024
PARENT INFO
Parent / Guardian Name*

First NameLast Name
Relationship to Youth*
Please select one
Parent / Guardian Email*
Parent / Guardian Cell Number*
Please enter your best contact number
Address*

Street Address

Street Address Line 2 (enter Apt / Unit #)

CityState / Province

Postal / Zip Code
** EMERGENCY CONTACT & PHONE NUMBER*
i.e. Joan Smith, 443-444-1212
APPLICATION QUESTIONS

Please answer all of the following questions as completely as possible. The answers to these questions will aid us in the mentor matching process.
1. Why do you/your child want to participate in a mentoring program? *
2. Is your child available to meet with a mentor a minimum of one hour per week via phone, text, FaceTIme or by email?*
3. Is your child available to meet in-person from 10:00 AM - 11:30 AM for our sessions on the 3rd Sunday of each month?*
4. Is your child available to participate in community outreach activities and scheduled trips?*
5. Please explain any particular scheduling issues that you may have, if applicable.
By submitting this form, you agree to the following:
- I give my informed consent and permission for my child to participate in the Virtuous Steps Mentoring Program and its related activities.
- I agree to have my child follow all of the mentoring program guidelines and understand that any violation on my child’s part may result in suspension and/or termination of the mentoring relationship.
Parent's Signature*

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Virtuous Steps Girls - Mentoring Application

YOUTH / TEEN INFO

PARENT INFO

APPLICATION QUESTIONS