HOPE CENTER COMMUNITY CENTER OF NORTH MISSISSIPPI
Mentee Application
MENTEE APPLICATION
Child's Name
*
First Name
Last Name
What is the child's preferred name?
*
Child's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Email
*
example@example.com
Child's Birthdate
*
-
Month
-
Day
Year
Date
Child's Gender
*
Male
Female
Parent or Guardian's Name:
*
First Name
Last Name
Parent's Email:
*
example@example.com
Parent's Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
What School Does The Child Attend?
*
Child's Grade
*
What would you like to learn more about or become better at with the help of a mentor?
*
What days of the week are best for you to participate in activities? (Select all that apply)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What time of day works best for you? (Select all that apply)
*
Mornings
Afternoons
Evenings
Weekends
As the Parent or Guardian of the child, do you give your permission for photographs and videos to be taken of your child and used in social media, The Hope Center website, and other advertising and marketing materials?
*
Yes
No
Submit
Should be Empty: