Mentee Application

Youth's Full Name:
Gender:
Age:
Youth Phone(s)
Email
Are you the mentee, parent/guardian, or a community partner referring?
Parent or Guardian #1 Name:
Relationship:
Full Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Parent/Guardian Phone:
Parent/Guardian Email:
Parent/Guardian #2 Name:
Text
Full Address:
Parent/Guardian Phone:
How did you hear of Rogue Valley Mentoring
Parent/Guardian/Agency: Has the child/youth asked/agreed to have a mentor?
If you are a community partner, please share who you are. If not, you may ignore this.
Mentee: Are you able to make a 1-year commitment to your mentoring relationship?
Mentee: Do you know of any upcoming change in our life that may impact your involvement with Rogue Valley Mentoring?
If yes to the above question, please explain:
Why do you wanted to be mentored through Rogue Valley Mentoring?

What are some values and beliefs that are important to you?
Please list your skills, hobbies, interest, languages, etc.
Are you in therapy currently and if so, has there been a diagnosis of any kind determined regarding your health?
What do you hope to get out of having a mentor?
Is there anything else that you would like us or your mentor to know about you?
By checking 'yes' you agree that all of the above information is correct. This will act as a digital signature confirming this.
Yes