Apply For Mentorship
Join us for our 10 week mentorship program. Building legacy, rebuilding relationships, and growing as a father.
Name
First Name
Last Name
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
Email
example@example.com
Date Of Birth:
Number of Children You Are Responsible For? Ages? Do you need childcare assistance during weekly sessions?
Do you have any child support obligations?
Yes
No
Waiting for Court Ruling
Substance Use History: If Not Applicable put NA. Primary Substance(s) of Concern? Age of first use? Date of Last use? Current Recovery Support? (Meetings, Sponsor Etc)
Do you need housing support?
Yes
No
Why are you interested in joining the Fathers First Program? What do you hope to gain?
Do you have reliable transportation to attend each session? Do you require interpretation or accessibility services?
I understand that this is a 10 week commitment and I agree to actively and respectfully participate in each sessions.
Yes
No
Submit
Should be Empty: