Mentee Application Parent/Guardian Application Thanks so much for your interest in our Mentor Program. We work hard to find the best mentor match for your child. Please fill out the form below, and we will get in touch with you regarding next steps. Please enable JavaScript in your browser to complete this form.Parent/Guardian Name *FirstLastIf two parents or guardians in household, please list both names.FirstLastChild's Name *FirstLastChild's Date of Birth *Child's GenderFemaleMaleNon-binaryIf you would like to share child's preferred pronouns or other info, please do so here:Mailing Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIs the physical address the same the mailing address? *YesNoPhysical AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail Address *Phone Number *On-island Emergency Contact *FirstLastContact's Relationship to the child *Emergency Contact's Phone Number *Household type. Please check all that apply:Single Parent HouseholdDual Parent HouseholdMulti-generational HouseholdPlease check all that apply:Our family qualifies for free or reduced lunch at the public schoolOur family does not attend public schoolEnglish is the second language in the homeIn order to make the best and most helpful mentor match for your child, please help us get to know them by describing their personality, strengths, hopes, interests, weaknesses etc. Include any physical, emotional or mental health issues. Why would you like to pursue a mentorship for your child?How does your child feel about the prospect of having a mentor?What sort of person do you think would be a good mentor for your child?Does your child have any allergies or medical conditions? Please put a check next to all activities in which your child takes a strong interest:AnimalsAutomotive/EnginesBakingBaseballBasketballBeach WalkingBike RidingBoard GamesBoatingBowlingCampingCodingComputersCookingArts & CraftsCrosswordsDancingDramaDrawing & PaintingFarm activitiesFishingFlyingFrisbeeGardeningGolfGymnasticsHikingHorseback RidingImprovLegosMartial ArtsMoviesMuseumsMusicRacquet Sports (Tennis, Badminton, Ping Pong)ReadingRoller SkatingRunningSailingSewing (Including crochet, knitting, weaving)SingingSkateboardingSoccerSwimmingVideo GamesVolleyballWoodworkingWritingPlease describe any other hobbies or interests your children has:NameSubmit
