General Mentee Application

Mentee Application
Save Our Youth will collect information about your child’s identity and ask your child to complete surveys in order to best serve your child and improve and evaluate our program. This information will not be shared with anyone outside the organization and is stored securely.

Please complete in one sitting as the form may not save your progress.

You must click SUBMIT at the bottom when done.
How did you hear about Save Our Youth?*
Date*

MonthDayYear
Child/Youth Name*

First NameLast Name
Gender*

MaleFemaleOther
So we can best support them, does the youth identify as LGBTQ?*
Age (must be between 10 and 17)*
Date of Birth*

MonthDayYear
Date
Child/Youth Email (if applicable)
example@example.com
Child/Youth Cell Phone (if applicable)
Address*

Street Address

Street Address Line 2

CityState

ZIP
School*
Grade*
Parent/Guardian Name(s)*
Email
Relationship to Child*
Main/Cell Phone *
Cell Phone

Area CodePhone Number
Other Phone
Emergency Contact (different from parent, if applicable)

First NameLast Name
Phone Number
Relationship to Child
Email
example@example.com