Mentee Application
Section 1: Applicant Information
Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Nonbinary
Male Trans
Female Trans
Prefer Not to Say
Race/ Ethnicity
*
Asian - Filipino
Asian - Japanese
Asian - Chinese
Asian - Indian
Asian - Korean
Asian - Other
Black or African American
Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano
Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican
Middle Eastern or North African
Pacific Islander - Chamorro
Pacific Islander - Native Hawaiian
Pacific Islander - Samoan
Pacific Islander - Other
White or Caucasian
Other
Parent/ Guardian #1 Name
*
First Name
Last Name
Parent/ Guardian #2 Name
First Name
Last Name
Parent/ Guardian #1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/ Guardian #1 Email
*
example@example.com
Parent/ Guardian #2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/ Guardian #2 Email
example@example.com
Preferred Method of Contact
*
Parent/ Guardian #1 Phone Number
Parent/ Guardian #1 Email
Parent/ Guardian #2 Email
Parent/ Guardian #2 Phone Number
Preferred Time to Contact You
*
Afternoon (12 pm- 5 pm)
Evening (6 pm- 8 pm)
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have plans to move out of Los Angeles County in the next year or so?
*
Yes
No
Not at the moment
Emergency Contact
Name
*
First Name
Last Name
Personal Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship To You:
*
Parent
Sibling
Other Family Relative
Guardian
Caregiver
Other
Section 2: Educational Background
School Name (Most Recent)
*
Grade Level
*
Section 3: Goals and Aspirations
What are your short-term career or personal goals? (Please list 2-3 goals)
*
What are your long-term career or personal aspirations?
*
Describe any challenges you have faced/ are facing in achieving your goals.
*
Section 4: Mentorship Expectations
Have you previously been a mentee here or anywhere else?
*
Please Select
Yes (SoLa Foundation, Big Brother Big Sister, other)
No
Why do you want to be a mentee?
*
What are some unique qualities or skills that you possess that you believe will help be an amazing mentee?
*
What specific areas do you hope to receive guidance on? (Check all that apply)
*
Please Select
Academic Support
Career Planning
Personal Development
Networking
Goal Setting
Other (Please specify):
If you chose "other" please specify below:
What qualities do you look for in a mentor?
*
Are you willing to spend a total of 3-5 hours with your mentor at least three times a month for our Community-Based Program? (If not, please look at other programs on our website.)
*
Yes
No
Are you willing to make a one-year commitment to the program?
*
Yes
No
Do you have any concerns about your ability to fulfill a minimum of 1-year commitment requirement to go on outings two/ three times a month for a minimum of 3-5 hrs total?
*
Do you anticipate any significant life changes over the next year or have you had any this past year? (ie. school changes, moving, etc.)
*
Are you available during weekends?
*
Yes
No
Have you ever been denied acceptance or released from service as a mentee/ participant for another youth-serving organization?
*
Yes
No
Section 5: Personal Interests and Hobbies
Please provide at least three references below: Eligible reference pool: Those within your network you have known for at least one year, someone from your school (e.g., teachers, community leaders, coaches), or family.
List your hobbies and interests:
*
Are you involved in any extracurricular activities or community service? Please describe.
*
Section 6: Additional Information
Please provide at least three references below: Eligible reference pool: Those within your network you have known for at least one year, someone from your school (e.g., teachers, community leaders, coaches), or family.
Have you ever been diagnosed with any mental/ physical health condition?
*
Do you have any special needs or require any accommodations?
*
Is there any other information you would like to share that will help us get to know you better?
*
Section 7: References
Please provide at least three references below: Eligible reference pool: Those within your network you have known for at least one year, someone from your school (e.g., teachers, community leaders, coaches), or family.
Name
*
First Name
Last Name
Relationship
*
Company Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Name
*
First Name
Last Name
Relationship
*
Company Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Name
*
First Name
Last Name
Relationship
*
Company Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Acknowledgment
Check boxes to acknowledge each statement.
*
I certify that all information I provided in this document is correct and truthful to the best of my knowledge.
I understand that the information collected from this form will be used for recruitment and evaluation purposes only. All data will be strictly confidential.
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