Lift Career Resource Center Mentee Form
Please complete this form in entirety!
Street Address Line 2
State / Province
Postal / Zip Code
Work Phone Number
Social Security Number
Caucasian / White
Hispanic / Latino
Name of school you attend, if you attend school at present.
Name of emergency contact
Phone number for person we should contact in case of emergency.
Relationship to you? (Example: Parent, guardian, friend)
What day are you available to meet with your mentor? Please indicate if you prefer AM or PM.
Are you available to meet with you mentor or attend training sessions eight hours per month (2 hours per week) and have contact at least once a week with your mentor for the period of one year?
Please answer all of the following questions as completely as possible.
Why do you wish to participate in a mentoring program?
Briefly describe your expectations of Lift Career Resource Center.
Please explain any scheduling issues you might have?
Are you willing to attend an initial mentee training session and at minimum two training sessions per year after being matched with your mentor?
Describe your school performance, including grades, homework, attendance, behaviours.
Are you currently experiencing problems where you live or at school?
Have you experienced any traumatic events (i.e. death in the family, abuse) If yes please provide details.
Please provide any additional background information that you feel may be helpful to Lift Career Resource Center in matching you with appropriate mentor.
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