Become a Mentee

First Name *

Last Name *

Date of Birth

Home Phone Number *

Alternate Phone Number

Email Address

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

School Name

School Phone Number

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Current Grade

Preferred Mailing Address *

Same as Home

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Are you livingWith FamilyWith FriendsWith RelativesOn your Own

Emergency Contact

Relationship

Contact Phone Number

Education and Training

School: Grade/Level Completed/Year Completed/Certificate/Diploma/Degree *

Other Certification

Hobbies or Interests

Community Involvement/Volunteering

Have you ever been convicted of a criminal offence for which you have not been pardoned? *YesNo

Are there specific activities you would like to do with your mentor? If so, please list them

How much time would you like to spend with your mentor? *Daytrips, week-ends, etc... (Occasionally)As much as possible, up to 6 months (Short-term)As much as possible past 6 months (Long-term)

if Other please specify

Do you have an idea as to what career(s) you want to go into? If so, what career(s) is it?

How are you going to get into this career(s)?

Do you currently have a job? *YESNO

If Yes, what type of job is it?

How many hours a week do you work?

What are you learning from this job that will help you in your future career?

What do you see yourself doing in 6 months? One year? in 3 years?

Which one of the following do you see yourself as more? *The strong and silent typeA mixture of both depending on my moodThe life of any gathering

List 3 qualities that are very important to you in a friend

If Other please specify0 / 100

Why do you want to be mentored? *

What do you consider to be important in a mentoring relationship? *

What do you envision achieving in your mentoring relationship? What activities do you have in mind? *

What type of environment do you work better in? *

StructuredFlexible

What do you like about yourself that you would like to share with a mentor? *0 / 150

Are you *

privateopenoutgoinglaid back and observant

Please share anything else that you think could help us make the best match *0 / 200

Preferred Mailing Address *

Education and Training

What do you see a mentor doing for you? *

Which area do you reside closest to? *

What type of environment do you work better in? *

Are you *