Bridging Futures Mentee Application

The Bridging Futures Mentorship Program is designed to help young people like you build confidence, strengthen your communication skills, and become strong self-advocates and future leaders.

Through a supportive mentoring relationship, you’ll be paired with a mentor who will guide and encourage you as you explore your goals, prepare for college or your career, and develop the skills you need to succeed.

This program is about more than just personal growth — it’s about empowering you to lead and make a difference. Along the way, you’ll gain tools, experiences, and connections that can help you step into leadership roles in your community. One day, you may even inspire others by giving back through advocacy, mentorship, or service.

Your voice matters. Your goals matter. And this program is here to help you build the future you want.

BASIC REQUIREMENTS

The Bridging Futures welcomes applications from teens who are currently in middle and high school. For middle schoolers, we accept applications from individuals who are in 7th or 8th grade. For high schoolers, we accept applications from individuals who are in 9th or 10th grade. The overall age is 12-16 years old. This program is FREE! All you need to do is fill out this application.

To qualify, applicants must have a pre-lingual bilateral hearing loss in the mild to profound range or a pre-lingual unilateral hearing loss in the moderate to profound range (degrees of hearing loss: Moderate: 41 to 55 dB; Moderately severe: 56 to 70 dB; Severe: 71 to 90 dB; Profound: 91+ dB). Applicants must also use Listening and Spoken Language your primary method of communication.

COMITTMENT TO BEING A MENTEE

Meet once a month from March-August 2026 with your mentor and the Bridging Futures team on Zoom for your required monthly meeting. During each montly meeting with your mentor, you will work through activities from our curriculum on topics such as college readiness, self-advocacy, identity, & goal setting.
- Please note- You will be able to communicate with your mentor throughout the month using a virtual mentoring platform- Mentornity. It is encouraged to do this to continue to build upon your relationship with your mentor.
Monthly Meeting Dates and Times:
- Wednesday, March 18, 2026 @ 7:30-9pm EST (Safety Training)
- Wednesday, April 22, 2026 @ 7:30-8:45pm EST
- Wednesday, May 27, 2026 @ 7:30-8:45pm EST
- Wednesday, June 24, 2026 @ 7:30-8:45pm EST
- Wednesday, July 22, 2026 @ 7:30-8:45pm EST
- Wednesday, August 26, 2026 @ 7:30-8:45pm EST
Must complete a mentoring safety program certification. This will be a group training on Zoom offered at the first monthly meeting on Wednesday, March 18, 2026 from 7:30-9pm EST. *Your parent is required to attend this training with you.*
Commit up to 3-5 hours a month to ensure effective mentoring.
Complete monthly match support check in survey and receive any additional support needed from Youth Programs Manager.

PARENTAL COMMITMENT

Attend required group mentoring safety training which will be held on Wednesday, March 18, 2026 from 7:30-9pm EST on Zoom.
Support your child and their involvment with the Bridging Futures Mentoring program.
Inquire about your child's mentoring relationship on a regular basis.
Complete bi-monthly match support check in survey and receive any additional support needed from Youth Programs Manager.

APPLICATION SUBMISSION VERIFICATION (IMPORTANT)

You must fill your email into the email validator field of the application. After you've submitted your email, you will receive a confirmation email from jotform. If you do not receive this confirmation, it means your application is not complete. You can contact AG Bell at bridgingfutures@agbell.org if you do not receive a confirmation email from jotform.

Completed Applications must be received by AG Bell by February 13th, 2026.

Please complete your application online by using this form.

The applications are reviewed by a committee and teens who are admitted to the program are notified mid-late February 2026.

Please note that if selected for the program, participants will be asked to provide financial information. AG Bell collects this information to determine eligibility for need-based support within our youth programs. Participants in this college-preparatory mentoring program may be eligible for scholarships and future higher education financial assistance. Collecting financial information allows AG Bell to equitably award support, reduce financial barriers, and ensure access for students with demonstrated financial need. All information is kept confidential and used solely for scholarship and support determinations.

If you have any questions or need further assistance, please email us at bridgingfutures@agbell.org.

Applicant / Teen Name*

First NameLast Name

MaleFemaleOther

Preferred Pronouns*

Ethnicity*

Date of Birth*

MonthDayYear

Year in School*

This should be the grade you are currently in during the 2025-2026 academic year.

Applicant / Teen E-mail*

Confirmation EmailPlease provide a personal email address, NOT a school email address, as the emails do not always go through due to being blocked or are considered spam.

Applicant / Teen Cell Phone Number*

Area CodePhone Number

Parent / Guardian Name*

First NameLast Name

FatherMotherLegal Guardian

Parent / Guardian Cell Phone Number*

Area CodePhone Number

We will communicate with you using E-mail – a valid e-mail address is required for sharing time-sensitive information and helping you prepare for the program. Please be sure to add bridgingfutures@agbell.org to your e-mail address book. You will ONLY receive emails pertinent to the Bridging Futures Program.

Parent / Guardian E-mail*

Email Verification - you will receive a confirmation from jot form after submitting the email verification.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Father's/Legal Guardian's Occupation *

Mother's/Legal Guardian's Occupation *

Total number of children in the household, including the applicant: *

Please provide proof of annual income. If in the US, please upload your most recent tax return or W2 form. If outside of the US, please provide an affidavit verifying income. *

Browse Files

How old was your child when they were diagnosed with hearing loss?*

Pre-lingual means before your child has learned to speak or understand language, typically by their 4th birthday.

SensorineuralConductiveMixed

BilateralUnilateral in the Left earUnilateral in the Right ear

Indicate the amplification device(s) used by the teen:

Rows	Left Ear	Right Ear
Hearing Aid(s):
BAHA (s):
Cochlear Implant (s):

Age at which the teen first received hearing aids:*

If this does not apply to your child, please write in N/A.

If applicable, age at which your teen received their first cochlear implant:*

If this does not apply to your child, please write N/A.

What brand is your teen's hearing device? *

Please upload audiogram information here.*

Upload a File

Audiogram (or similar) should be from the last 2 years.

What method(s) of communication does your teen use at home and in school? Check all that apply.

Which supports does your teen currently use at school? Check all that apply.

What are you hoping your child will gain from participating in the Bridging Futures Mentorship Program? *

YesNo

Why are you interested in having a mentor and joining the Bridging Futures mentoring program? *

Tell us a little about yourself. What are a few things you enjoy doing or learning about?*

What is one thing you feel proud of about yourself or something you’re good at?*

How is school going for you, and is there anything you’d like more support or confidence in?*

What is one goal—big or small—you’d like to work on over the next six months?*

What are some areas in your life where you'd like support or guidance (e.g., personal or academic, advocacy, college readiness, accommodations, etc.) *

What kind of mentor do you think you would connect well with (personality, interests, style)?*

Are there any mentor qualities or personality types you prefer not to be matched with?*

How do you like people to communicate with you (friendly conversation, clear instructions, humor, encouragement, etc.)?*

How comfortable do you feel talking with someone new over Zoom, and what helps you feel at ease?*

This program meets once a month for 6 months. You will be able to communicate with your mentor throughout the month outside of the monthly scheduled meeting through the Mentornity Portal (Virtual Mentoring Platform). Ideally, you would continue on with your mentor each year until you graduate from High School. How do you feel about that commitment, and what do you hope to get out of it?*

If there's anything else you'd like to share with the committee about you, please include it here.

Browse Files

I hereby grant permission to the Alexander Graham Bell Association for the Deaf and Hard of Hearing (AG Bell) to use the photograph(s) and video(s) of {applicant} for unlimited use in any AG Bell publications, periodicals, brochures, displays, booklets, website and in any of AG Bell’s public relations or fundraising activities. I give and grant to AG Bell and its designees, licensees, successors and assigns, the right to use, publish and copyright, my child’s name, voice, likeness, actions and biographical data, in whole or in part. I hereby waive any right that my child or I may have to inspect or approve the media, any materials that may be used in connection with the media, or the use to which it may be applied.*

AGREEMENT: This is to certify that I am the parent/legal guardian of the aforementioned Bridging Futures Applicant. I support my teen’s application for the AG Bell Bridging Futures program planned for 2026 via Zoom every month. By signing my name below, I indicate that I have read, understand and accept the Terms and Conditions provided and the Agreement as stated above and affirm that all the information provided in this application is correct and complete to the best of my knowledge.

Signature of Agreement*

Bridging Futures Mentee Application

Contact Information

Parent / Guardian Information

Financial Information

Tell Us About Your Teen's Hearing Loss

Communication

Parent/Legal Guardian Essay

Application Questions

Tell us about YOU video. Please upload a 1 to 2 minute video in an MP4 or .mov format. In the video, tell us your name, where you are from, two things that are unique about you, and why you want to participate in the Bridging Futures program?

Photo and Video Release