Mentee Sign Up Form

Mentee Sign Up Form

We are excited for you to join our mentorship program! This is an opportunity to connect with a female professional in your preferred career field. Your mentor will provide an encouraging environment with guidance and support on your journey to success! Feel free to browse our mentor directory on our website (www.pryortosuccessinc.org). Please complete the entire questionnaire. All information is kept private and will not be shared without your permission. If you have any questions, contact us via email pryor2success@gmail.com or phone 770-546-6243. We look forward to meeting you!
Date

MonthDayYear
Date
Name*

First NameLast Name
Age*
DOB*

MonthDayYear
Date
Grade Level*
School*
Ethnicity

American Indian or Alaska NativeWhiteAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderHispanic or LatinoOther
Telephone Number *
Please enter a valid phone number.
Email*
example@example.com
High school students only: Do you plan to attend college?*

YesNoUndecidedNot in high school
If yes, what schools are you currently interested in?*
What career field are you interested in?*
Browse our mentorship directory. If there's a particular mentor you'd like to work with, please type her name here.
What do you hope to gain from the PTS Mentorship Program?*
Please select a date and time you are available within the next 2 weeks for a 30-minute virtual meeting. In this meeting, we will introduce you to your potential mentor, uncover your needs, and discuss your expectations for the program. We are excited to work with you!
Appointment
Applicant Signature*

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Date Signed*

MonthDayYear
Date
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