HEROES Mentee Application - Spring 2023
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HEROES Mentee Application - Spring 2023
Student Personal Email
*
Please do not put your school email because sometimes google does not allow outside people to email you
Are you a new or returning student to the HEROES Program?
*
New student
Returning student
Student Name
*
Student Phone Number
*
Format: (000) 000-0000.
What is your parent/guardian's email?
*
What is your parent's phone number?
*
Cannot be the same as student's phone number
Format: (000) 000-0000.
What school do you attend?
*
City
*
Please Select
Queens
Bronx
Brooklyn
Manhattan
Rochester
Buffalo
Syracuse
Other
Guidance Counselor's Name
*
If you are new to high school, please state that
Grade (as of January 2023)
*
Please Select
9th grade
10th grade
11th grade
12th grade
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Demographics
What is your gender identity?
*
Please Select
Male
Female
Non-Binary
Race/Ethnicity
*
Please Select
American Indian or Alaska Native
Asian
South Asian
Black or African American
Hispanic/Latinx
White/Caucasian
Multi Racial
Native Hawaiian or Other Pacific Islander
Do any of the following apply to you?
*
I am a low-income student
I am a first-generation student (Being a first-generation college student means that you are the first person in your immediate family to attend college–ie: neither of your parents have a college degree.)
I am apart of the BIPOC community (Black, Indigenous, People of Color)
None of these apply to me
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Student Interest
How did you hear about our program?
*
Please Select
Emailed Flyer
Recommendation by School Counselor
Already in HEROES
Instagram
Program Referral
Would you like to go to college?
*
Please Select
Yes
No
Unsure
What is your understanding of the HEROES Program?
*
Hint: you may visit our website: heroesyouthmentorship.org to learn more
Why do you want a mentor?
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Why do you think having a mentor will be beneficial to you?
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What are your career plans? (Ex: what do you want to be when you grow up?)
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At HEROES, we require HS students to be available to meet with their mentors on a bi-weekly basis. Will you be able to have time in your schedule to commit to this program? How will you ensure you have this time set up in your schedule?
*
What are the dates and time of our program?
*
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Acknowledgement
Scheduling:
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I will be available to meet with my mentor on a bi-weekly basis per the calendar
As you know, HEROES will be a virtual mentorship program where students will be matched with a mentor at the end of January. We require all mentees to have access to an electronic device, the internet and have Zoom downloaded. Will you be able to meet these requirements?
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Yes, I will have access to an electronic device, the internet, and will have Zoom downloaded
All mentees will have to attend a mandatory student orientation. Do you agree to this commitment?
*
Yes, I agree and will be at the mandatory student orientation
Do you have any additional questions or concerns?
Submit
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