Group Mentoring Youth Interest Form

Group Mentoring Youth Interest Form

Group Mentoring Youth Interest Form for Young Men Ages 9–15. Preserve the original structure and wording from the referenced document. Fields are optional unless marked required.
Tell Us About You (Youth)
Full Name

First NameMiddle NameLast Name
Age
Grade
School Attended
City of Residence
Which Group Interests You?
Mentoring group interested in attending
If Barnesville, can you attend on the second and fourth Saturdays?
What Do You Enjoy?
What do you like doing in your free time?

Other
Three things you really enjoy doing
Something you believe you are good at
Something you would like to become better at
What Would Make Mentoring Fun?
Activities you would like to do in the mentoring group

Other
Choose your three favorite activities from the list above
One activity you wish a mentoring program would offer
What Would You Like Help With?
If you could improve one thing about yourself this year what it would be
Your Goals and Future
One goal you would like to reach this year
What sometimes keeps you from reaching your goals

Other
What kind of job or career sounds interesting to you right now
Where you would like to see yourself five years from now
What you would want to ask someone from any career if you could meet them
Your Honest Opinion
Whose idea was it for you to join mentoring?

Other
How do you feel about joining the mentoring group?
What would help you feel comfortable in the group?
What would make you want to keep coming back?
Is there anything you would like your mentor to know about you?
Parent/Guardian Information
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
Which Location Interests Your Family

Other
Can Transportation Be Provided to the Selected Location?
What Would You Most Like Your Child to Gain From Mentoring?
Any Strengths, Needs, or Concerns That Would Help Support Your Child
Parent/Guardian Acknowledgment & Signature
Parent/Guardian Acknowledgment
Parent/Guardian Signature
Date

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

Group Mentoring Youth Interest Form

Tell Us About You (Youth)

Which Group Interests You?

What Do You Enjoy?

What Would Make Mentoring Fun?

What Would You Like Help With?

Your Goals and Future

Your Honest Opinion

Parent/Guardian Information

Parent/Guardian Acknowledgment & Signature