The Tobin Teen Mentorship Program
2026/2027
Mentee: Grades 6-8
Mentees Name
*
First Name
Last Name
Parent's Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent's Email
*
example@example.com
Mentee's Date of Birth
*
-
Month
-
Day
Year
Date
Gender:
*
Male
Female
Grade
*
6
7
8
School
*
I've filled out the one-time teen info form (CTeenAtlanta.com/teeninfo)
*
Yes
Please tell us a bit about your teen, as well as what activities interest them and what subjects you’d like them to be mentored in:
*
What subjects and electives interest your teen?
*
Math
Science
History
Judaics
English
Hebrew
Chess
Other (Please specify)
Mentee
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Payment for all twelve sessions
$360.00
$
360.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
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December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Payment Plan Option: Payment Plant/Scholarship - as discussed with Talya:
$0.00
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