Mentee Application Form

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Welcome and Thank You for Your Interest in being a Mentee!

You made it to the application! This means you are interested in having a STEM mentor to support you as you continue to grow. Mentoring changed the life of our founder, Janet Phan and we want that kind of impact for you too! We look forward to reading your application.

Check out Thriving Elements Founder Janet T. Phan TED Talk Here

If you have questions in the meantime please email mentoring@thrivingelements.org.

Email *

Record my email address with my response

Email *

(Do not use school email)

First Name *

Last Name *

Phone number *

Street Address *

City *

State *

Zip Code *

Country *

Date of Birth (MM/DD/YYYY) *

YYYY

Preferred Method of Contact (Phone/Email/Text) *

Phone

Text

Required

Best Time(s) of Day to Contact You

Morning

Afternoon

Evening

Gender *

Male

Female

Other

Ethnic Background *

Asian

Hispanic or Latino

Black or African American

Native American or Alaska Native

Native Hawaiian or Other Pacific Islander

White

Other

Prefer not to answer

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