Mentee Registration Form

Mentee Registration Form

Fill out the form carefully for registration
Mentee Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mentee E-mail
example@example.com
Mobile Number
Phone Number
Work Number
School/Company
Grade/Level
Why do you want to be a mentee:
________________________________________________________________________________________

What are your goals/objectives:
________________________________________________________________________________________
________________________________________________________________________________________

What do you aim to achieve from this mentoring relationship:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Please indicate how you would prefer to meet with your mentor face-to-face meetings
___ Video conferencing (Skype, Zoom, etc.)
___ Phone

How often would you be prepared to have contact with your mentor:
___ Once a week
___ Twice a week
___ Twice a month
___ Once a month

Additional information:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Should be Empty: