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Mentee Application

Please complete the information below.

. *This question is required.

First Name *This question is required.

Middle Name

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

Gender *This question is required.

Ethnicity *This question is required.

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

Street Address *This question is required.

Apt/Suite

City *This question is required.

State *This question is required.

Zip

Grade *This question is required.

School *This question is required.

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

1. Parent/Guardian Name *This question is required.

2. Parent/Guardian Contact Information (phone number and email) *This question is required.

3. Are there other children or youth in the home that would benefit from having a mentor? *This question is required.

4. Kinship Mentoring is a voluntary youth mentoring program that focuses on quality time versus material items and expensive experiences. Is the child/youth interested in forming a new, trusting relationship with an adult and participating in activities? *This question is required.

5. How did you hear about Kinship Mentoring? *This question is required.

Please enter an 'other' value for this selection.

6. What are the youth's strengths and interests? *This question is required.

7. How would you rate their self-esteem? *This question is required.

8. What are the youth's challenges or struggles? *This question is required.

9. Has the youth experienced or been exposed to any of the following? *This question is required.

10. How would the youth benefit from mentoring? *This question is required.

11. I consent to be contacted by the Kinship Mentoring staff about this application. *This question is required.

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