Alpha Academy Mentorship Program

Are you a returning mentee?*

NoYes
Mentee Application
Today

MonthDayYear
Date
FormID
Mentee's Name

First NameLast NameSuffix
Mentee's Birth Date

MonthDayYear
Date
Mentee's Age
Calculated Age
Mentees's Grade
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mentee's School (If Anne Arundel County Public School)
Mentee's School (If not Anne Arundel County Public School)
School Type
Current GPA?
Current GPA?
Mentee's E-mail
example@example.com
Mentee's Phone Number
Please enter a valid phone number.
Parent's Name
Parent's Email
example@example.com
Parent's Home/Cell Phone
Parent's Work Phone
Preferred Method of Contact

EmailHome/Cell PhoneOffice Phone
Did your son have a mentor before our program?

YesNo
If yes, would you like for him to have the same mentor this time?

YesNo
Did he apply before and not receive a mentor?

YesNo
Do you prefer to receive news from ALPHA ACADEMY MENTORSHIP PROGRAM regarding upcoming events and other important information via email?

YesNo
How did you hear about the ALPHA ACADEMY MENTORSHIP PROGRAM? (Check all that apply)

FriendAlpha BrotherTeacherFamily memberAfter School ProgramChurchFacebookTwitter/XInstagram
Mentee Questions

The answers below are important as it helps us tailor our annual program to be most effective for the incoming class.
Why do you want, or need to take part in this mentoring program?
Have you participated in similar programs in the past? If so, what were your experiences?
What goals, experiences, and learnings do you hope to achieve during this program this year?
What professional disciplines are you interested in learning more about?
School clubs, sports, or any other activities you are involved in

13th ManAVIDBasketballBoxingBoy ScoutsChessChorusChurch UsherDrumsDronesFootballGolfFishingJack and JillLacrosseMartial ArtsMusicNJROTCP4GYPOrchestraPianoSoccerSTEMStudent GovernmentSwimmingTrackVideo GamesVolleyballWrestlingOther
Please list any school clubs, sports, or any other activities you are involved in.
Do you need tutoring/assistance with your grades/school work? If so, what subjects?
Do you need tutoring/assistance with your grades/school work? If so, what subjects?

MathScienceEnglishSocial StudiesHistoryWriting / Language ArtsOther
What professional disciplines do you have experience in, or are familiar with already?
Date

MonthDayYear
Date
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Mentee Application

Mentee Questions