Mentee Application Form for 1 on 1 mentoring and shadowing

First NameLast Name
Highest Educational Attainment
Current School (if applicable)
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Method of Contact

EmailTextPhone
Days of Availability

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Preferred Time of Day

Morning (8 AM – 12 PM)Afternoon (12 PM – 5 PM)Evening (5 PM – 9 PM)
Preference in mentorship (Check all that apply)*

1-on-1 MentoringShadowing a professional at Work
Career Interest*

MedicineDentistryPA (Physician Assistant)NursingNurse practionerPhD (scientist)Other
Please elaborate on career interest and goals
Should be Empty: