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Mentee Application
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Mentee Application
Background Information
.
Youth First Name
*
This question is required.
Youth Last Name
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Preferred Name
Gender
*
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-- Please Select --
Male
Female
Non-binary
Other
If you said other, please specify.
Pronouns
*
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He/Him/His
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Do you identify as LGBTQIA+?
*
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-- Please Select --
Yes
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Date of Birth
*
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This question requires a valid date format of MM/DD/YYYY.
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Street Address
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Apt/Suite
City
*
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State
*
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-- Please Select --
AK
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DE
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ID
IL
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Zip
*
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Youth Phone Number
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Type
*
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-- Please Select --
Cell/Mobile
Home
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Ethnicity
*
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Hispanic/Latino
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Race
*
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African
American Indian/Alaska Native
Asian
Black/African American
Middle Eastern
Native Hawaiian/Pacific Islander
Slavic
Two or More Races
Unknown
White/Caucasian
Other
If you said other, please specify.
Languages Spoken
*
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Mentee is living with
*
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-- Please Select --
mother
father
mother and father
grandparent
other relative
foster parent
other
If you said other, please specify.
Check all days & times below that you anticipate being available to spend time with your mentor. You will meet with your mentor to discuss transportation and other details; this information is to help us match you:
Monday
Morning
Afternoon
Evening
Tuesday
Morning
Afternoon
Evening
Wednesday
Morning
Afternoon
Evening
Thursday
Morning
Afternoon
Evening
Friday
Morning
Afternoon
Evening
Saturday
Morning
Afternoon
Evening
Sunday
Morning
Afternoon
Evening
How did you hear about Rogue Valley Mentoring?
*
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-- Please Select --
Search Engine (Google, Yahoo, etc.)
Friend/Word of Mouth
Referred by Another Organization
FaceBook
Instagram
Other
If you said other, please specify.
*
This question is required.
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About
About our Organization
History
Team & Partners
SO Health-E
Testimonials
Programs & Services
One-to-one Matches
Community Programs
Rising Resilient Summer Camp 2024
Summer Camp – Camp Counselors
Youth Leadership Advisory Board
UNIDOS
School Circles
Refer a Youth
Volunteer
Become a Mentor
Mentor Training Calendar
Contact
Donate
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