Mentor Interest & Readiness Form
Share your interest in mentoring with the Leave A Legacy Foundation. This form helps us discern alignment, readiness, and next steps together.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which program(s) are you interested in mentoring with?
*
From Blossom to Bloom (Women & Girls Mentoring)
Pure Purpose Program (Young Women Ages 14–30)
Women in Transition
Not sure yet – open to discussion
Have you mentored before (formally or informally)?
Yes
No
What life experience, insight, or perspective do you feel equipped to share as a mentor?
*
Please indicate your level of agreement with the following statements:
*
Rows
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I am committed to encouraging others without judgment
I understand the importance of confidentiality and boundaries
I am open to training, guidance, and accountability
I am willing to commit to consistency and follow-through
I believe mentorship should be supportive, respectful, and empowering
How does faith, purpose, or personal values influence your desire to serve as a mentor? (Optional)
How often are you available to mentor?
Monthly
Bi-weekly
Event-based
Not sure yet
Preferred mentoring format
In-person
Virtual
Hybrid
I understand this is an interest and readiness form. I acknowledge that mentor placement may require training, screening, and approval prior to participation.
*
I acknowledge and understand the process
Submit Mentor Interest
Should be Empty: