Application Form - Blossom Mentor

THE BLOSSOM PROJECT MENTOR Application Form

Application Deadline - December 18, 2025
Thank you for your interest in becoming a mentor with The Blossom Project. Our mentors play a vital role in guiding young women as they grow, build confidence, and develop leadership skills. Please complete the form below so we can learn more about you.
Section One Personal Data

Tell us about yourself
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Email *
Where the confirmation will be send to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Optional Informations

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation only and in no way affects your selection for college scholarship awards. However, providing this information may increase your opportunities for scholarships where donors have asked that priority consideration be given to students meeting certain demographic criteria (such as minority status, parent's place of employment, area of study, etc.)
Gender

Female
Are you a US citizen?

YesNo
Please check your veteran status.

VeteranChild of a VeteranGrandchild of a VeteranSpouse of a VeteranNone of the Above
What is your current occupation?

0/300
Do you have any mentoring, coaching or youth-related experiences?

YesNo
Do you have any certifications or training related to youth development, counseling, or education?

YesNo
Section 2 Interest in mentoring
Why do you want to become a mentor with The Blossom Project?
What personal strengths or skills do you bring to our mentorship community?
What age group(s) are you most comfortable working with?

Middle School Girls (Grades 6-8)High School Girls ( Grades 9-12)
Areas you are interested in mentoring (check all that apply):

Confidence & Self-EsteemLeadership DevelopmentAcademic SupportEmotional WellnessLife Skills / EtiquetteCareer ReadinessCreative Arts & ExpressionCommunity ServiceOther:
Section 3. Availability
How often are you available to mentor?

WeeklyBi-WeeklyMonthlyOccasional/As Needed
Preferred Meeting times

WeekdaysEveningsWeekends onlyAnytime, In Person
Section 4. Safety & Screening
Are you willing to under-go a background check?

YesNo
Have you ever been convicted of any criminal offense?

YesNo
Do you have reliable Transportation?

YesNo
Section 5. References
Please provide two references (professional or personal, no relatives).
Reference one (name, phone & email)
Reference two (name, phone & email)
Reference three (name, phone & email)
Section 6. Applicant's E-Signature
By submitting this application, I confirm that all information provided is true and accurate to the best of my knowledge. I understand that completing this form is the first step in the mentor selection process and does not guarantee placement.
Signature

Clear
Should be Empty:

THE BLOSSOM PROJECT MENTOR Application Form

Section One Personal Data

Section 2 Interest in mentoring

Section 3. Availability

Section 4. Safety & Screening

Section 5. References

Section 6. Applicant's E-Signature