Fatherhood Mentoring Application

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

3

Child's Mother's Full Name* This field is required.

First Name

Last Name

4

Child's Due Date/Birth Date* This field is required.

Date

5

Child's Full Name* This field is required.

First Name

Last Name

6

Preferred Office Location* This field is required.

Arvada

Aurora

Downtown Denver

Inverness/Englewood

7

Why do you want to join Alternatives' Fatherhood Mentoring?* This field is required.

8

What experience do you have with babies?* This field is required.

9

What are you most excited about as it relates to becoming a father?* This field is required.

10

What is your biggest concern as it relates to becoming a father?* This field is required.

11

How would you describe your relationship with your father (both past and present)?* This field is required.

12

What support do you have as a father?* This field is required.

13

How would you describe your relationship with the mother of your child?* This field is required.

14

Who is your biggest inspiration and why?* This field is required.

15

Describe your ideal Fatherhood Mentor.* This field is required.

16

Will you commit to meeting with your Fatherhood Mentor twice a month?* This field is required.

YESNO

17

Will you commit to completing any assigned homework?* This field is required.

YESNO

18

Will you respect your Fatherhood Mentor?

YESNO

19

Will you commit to having a good attitude and learning all aspects of becoming a better father?* This field is required.

YESNO

20

Signature* This field is required.By typing my name, I agree my electronic signature is the equivalent of my manual signature on this application.

21

Date submitted* This field is required.

Date