Mentor/Role Model Application
Thank you for your interest in connecting with a mentor or role model through The 13th Man. Our mission is to champion young men on their journey to greatness by providing guidance, support, and positive relationships. Please complete this application so we can learn more about you and pair you with a mentor who can best support your growth.
Full Name
*
First Name
Middle Name
Last Name
Email Address (if applicable)
example@example.com
Phone Number (if applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Full Name
*
First Name
Middle Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
What are your favorite subjects, activities, or hobbies?
*
What are one or two goals you’d like to achieve in the next year?
*
Are there specific areas where you feel a mentor could be most helpful? (Check all that apply)
*
Academic Support
Personal Growth/Character Development
Leadership Skills
Emotional Support/Encouragement
Family Support
If Family Support is selected, please specify:
Are you currently working with a mentor or role model?
*
Yes
No
Have you ever been assigned a mentor or role model in the past?
*
Yes
No
If yes, how would you describe your experience?
*
Excellent
Good
Average
Not Good
Please share anything about your past experience that would help us better support you:
Submit
Should be Empty: