Mentee Sign Up Form

Full Legal Name*

First NameLast Name

Preferred Name/Nickname *

Date of Birth*

Date

Age*

School*

Grade*

Parent/Guardian Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

T-Shirt Size*

Why do you want to be a part of our mentorship program?*

What are some things you'd like to learn?*

If you chose Other, please explain

What makes you a great teammate?*

Why do you think this program will benefit your child?*

How would you like you child to participate?*

Program Expectations

By signing below, Mentees agree to: