Lift As We Climb Mentorship Registration (FALL) 25'
The Hogue Foundation (Mentees Only)
Name (Mentee)
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Please Select
12
13
14
15
16
17
What school do you attend?
*
Race or Ethnicity
*
Gender
*
Please Select
Male
Female
N/A
Mentee Phone Number
*
Please enter a valid phone number.
Mentee Email
*
example@example.com
Address
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Email
*
example@example.com
Language Proficiencies
Your Hobbies and Interests
*
Visual Arts
Electronic Games
Film Travel
Music
Volunteering
Politics
Reading (Fantasy/Fiction)
Sports
Literary Works
Other
What Best Describes you
*
Outgoing
Business-oriented
Constructive
Empathetic
Funny
Lively
Intuitive
Passionate
Reserved
Reflective
Vibrant
Professional Interest or Expertise
*
Arts and Entertainment
Business and Development
Consultancy
Education
Engineering
Financial Services
Health Care and Medicine
Information Technology
Legal and Litigation
Marketing and Advertising
Non-Profit Administration
Politics
Publishing
Science and Technology
Which role you would like your Mentor to be in your life?
Colleague
Nurturer
Listener
Teacher
Motivator
Career Development
Life Coach
Industry Coach
Other
Areas where you hope your mentor will make an impact
Knowledge and Practice of Professional Etiquette
Focus and practice on the Field of Career
Professional Network Expansion
Personality Development
Communication Skills Improvement
Have you had mentoring before?
*
Yes
No
Your Preference of Communication with your Mentor
email
text
phone
Your Preferred Mentor
*
Male
Female
No preference
Are you interested in taking Civil Service exams? For example, a police officer, firefighter, court officer, and etc.
Yes
No
Your Personal Information
Tell us something about yourself
*
Are you planning to attend college? Please state why or why not and include major.
*
Where do you see yourself in five years
*
What are your expectations in this Mentoring program
Parent/Guardian Signature
*
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