Girl Level Up Mentorship Afterschool Program

Girl Level Up Inc. Mentorship After School Program

Selma, AL
Girl Level Up, Inc. is a fast-growing nonprofit organization committed to the path of girls’ lives and preparing them for long-term success. We work with girls, parents, caregivers, and stakeholders to ensure lasting impact through teaching advocacy, leadership, guidance, social-emotional intelligence, assertive self-expression, and healthy relationships. We are committed to giving girls the skills, resources, and confidence to thrive.
Date*

MonthDayYear
Girl's Full Name*

First NameMiddle NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian's Contact Information
Parent/Guardian Name*

First NameMiddle NameLast Name
Parent Email Address*
Relationship to Girl*
person referring girl to program
Phone Number*

Area CodePhone Number
Girl's Information
Current Grade Level*
Date of Birth*
Age*
Girl's Email
example@example.com
Girl's Phone Number

Area CodePhone Number
Girl, tell us about yourself

What do you want us to know about you?
Tell us about yourself (Interests/ Hobbies)*

List any awards, special skills, training, hobbies, or volunteer work.0/250
What do you hope to gain from this mentorship/afterschool program? What are you looking for in a mentor?*

0/250
List any physical limitations/conditions or allergies that we should be aware of*
Allergy
Authorized for Drop off/Pick up

The people below have my permission to drop off/ pick up my girl(s) from program.
Person 1:*

First NameLast Name
Contact Number*
Relationship to the applicant*
Person 2:

First NameLast Name
Contact Number
Relationship to the applicant
Program Commitments
As a program participant you must agree to abide by the guiding principles below:*

Being engaged: A girl should be accessible and committed to their development throughout the program.Being open: A girl should be honest about their goals, challenges, expectations, and concerns.Respecting others: A girl should respect their leaders, mentors and peers at all times.
Certify Here:*
Should be Empty:

Girl Level Up Inc. Mentorship After School Program

Parent/Guardian's Contact Information

Girl's Information

Girl, tell us about yourself

Authorized for Drop off/Pick up

Program Commitments