Kinship of the Perham Area

Mentee Information

First Name *This question is required.

Last Name *This question is required.

Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Street Address *This question is required.

Apt/Suite

City *This question is required.

Zip *This question is required.

Primary Phone Number *This question is required.

Secondary Phone Number

Ethnicity *This question is required.

If you said other, please specify.

Grade *This question is required.

School *This question is required.

If you said other, please specify. *This question is required.

Mentee is living with *This question is required.

If you said other, please specify.

Mentee Application