Jacob's Ladder Mentee Preferences

Jacob's Ladder Mentee Preferences

We want to learn more about you to match you with a mentor. Please answer as honestly as you can. If you feel uncomfortable answering a question not marked with an asterisk, you don't have to answer it.
Students name?*

First NameLast Name
Parent/Guardian's name?*

First NameLast Name
2nd Parent/Guardian's name?*

First NameLast Name
How old are you?*
What grade are you in?*
What is your phone number?
Please enter a valid phone number.
What is your living situation?*

I live with both parentsI live with one parentI live with my grandparentsI live with a guardianI live in foster careOther
Do you have any brothers or sisters?*

YesNo
What is your favorite food*
What extracurricular activities do you enjoy? (Choose all that apply)
What sports do you like?*

SoccerFootballBasketballBaseballSwimmingTennisCheerDanceGolfOtherNone
What is your favorite subject in school?*
What is your least favorite subject in school?*
How do you feel about your school performance?*

I do very wellI do okayI find some subjects hardI need extra help
Do you have a career path in mind or know what you want to do when you graduate high school?
What pets do you have?

DogsCatsFishFarm AnimalsNone
What are your favorite colors? (Choose up to 3)
What are your favorite TV shows or Movies?
How do you define your personality?*

Quiet/ShyOutgoing with lots of friendsSomewhere in the middle of shy and outgoingOff the charts crazyDepends on the day
How do you define your mental health?*

I'm pretty happy most of the timeI prefer to be aloneI prefer to be around peopleI get anxious easilyI just don't care about anythingI fluctuate between happy and sadI'm more sad than happyMy happiness depends on my circumstance at the time
Is there anything you want to share about yourself?
What would you like your mentor to help you with?
Should be Empty: