Power Forward Youth Leadership LLC Mentoring/Coaching Interest Application

Power Forward Youth Leadership LLC Mentoring/Coaching Interest Application

Please complete this form to share your child’s information, interests, support needs, program preferences, and acknowledgments before an initial consultation.
Applicant and Youth Information
Which program are you interested in for your child?
Parent/Guardian Full Name

First NameMiddle NameLast Name
Relationship to Youth
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
City and State
Preferred Method of Communication
Youth’s Full Name

First NameMiddle NameLast Name
Age
Current Grade
School Attending
Child Awareness and Participation Readiness
Does your child know that you are completing this mentoring interest form?
How interested is your child in participating?
Session Preferences and Scheduling
How would you prefer sessions to be held?
If you selected in-person or a combination, are you able to provide transportation to an agreed-upon public meeting location?
What days generally work best?
What times generally work best?
How often would you prefer your child to participate?
Strengths, Interests, and Support Needs
What are some of your child’s strengths?
What are some of your child’s interests or hobbies?

Other
Why are you seeking mentoring or coaching for your child?

Other
What would you most like to see your child gain from this experience?
Are there any challenges or concerns that would be helpful for us to understand?
Which statement best describes the support your child needs?
How does your child normally respond to goals, assignments, or action steps?
Would your child benefit from having specific goals and progress check-ins?
Would you like appropriate parent/guardian progress updates?
Program Selection, Experience, and Consultation Questions
Which program would you like to pursue?
Please briefly explain why you selected this option.
Has your child participated in mentoring or coaching before?
If yes, please briefly describe the experience.
Is there anything else you would like us to know about your child or your expectations for the program?
What questions would you like answered during the initial consultation?
Acknowledgments and Consent to Contact
I understand that submitting this form does not guarantee acceptance or enrollment.
I understand that Power Forward Youth Leadership LLC provides mentoring, coaching, leadership development, and positive youth-development services—not professional counseling, therapy, or mental-health treatment.
I understand that program availability, format, scheduling, fees, and expectations will be discussed before enrollment.
I give Power Forward Youth Leadership LLC permission to contact me regarding this inquiry.
Parent/Guardian Full Name

First NameMiddle NameLast Name
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Power Forward Youth Leadership LLC Mentoring/Coaching Interest Application

Applicant and Youth Information

Child Awareness and Participation Readiness

Session Preferences and Scheduling

Strengths, Interests, and Support Needs

Program Selection, Experience, and Consultation Questions

Acknowledgments and Consent to Contact