Girls/Boyz First!! Mentoring Program
Mentee Application
Date
Received:
We are glad that you want a mentor! Please answer
these questions so that we can try to make the best "match." If you
do not feel comfortable answering a question, you may leave it blank. The more
we know about you, the better we can match you with your mentor.
Name:
__________________________________________________________
(last) (first)
(middle)
Address:
________________________________________________________
_______________________________________________________________
Telephone Number(s):
_______________________________________________
(home) (work)
E-Mail
Address____________________________________________________
Parent's/Guardian's
Name____________________________________________
Parent's/Guardian's
phone_______________________________
Parent's/Guardian's Address (if different)
________________________________________________________________
________________________________________________________________
Birthdate: Month/
Day/ Year Sex:
M F
School___________________Grade______________Teacher_______________
Favorite subject__________________ Least favorite subject________________
What activities, clubs, sports, are you involved
with?
What are your hobbies?
When would you like to meet with your mentor? (check all that apply)
After school what
days and times________________________________
Weekends what
day(s) and times_______________________________
I
am . . .
I
like to . . .
My
favorite movie is:
My
favorite music is:
My
favorite book is:
My
favorite T.V. show is:
On
a lazy summer afternoon I would most like to:
Please return forms to Ivy
Zeller,