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WriteGirl Mentee Registration Form
Thanks for your interest in joining WriteGirl! Please complete the form below. NOTE: We cannot process registration until we receive your Parent/Guardian Consent Form. Please send the Parent/Guardian Consent Form via mail, email or fax.
First Name *
Your answer
Last Name *
Your answer
Grade in the Fall of 2018 *
Your answer
What is your current age? *
Your answer
Cell phone number (if any)
Your answer
Home phone number (Please note that we need at least one phone number for our files)
Your answer
Primary email Address (Email is our primary form of communication, so we need at least one email address)
Your answer
Parent or Guardian Name/s *
Your answer
Parent/Guardian primary email address *
Your answer
Parent/Guardian secondary email address
Your answer
Parent/Guardian cell phone number (Please note that we need at least one parent phone number for our files)
Your answer
Parent/Guardian home phone number
Your answer
Parent/Guardian work phone number
Your answer
Home Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Date of Birth *
MM
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DD
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YYYY
Name of School (in Fall 2018) *
Your answer
Name of English Teacher (in Fall 2018, if known)
Your answer
English Teacher's Email Address (if known)
Your answer
Do you have any physical or health conditions we should be aware of? If yes, please describe.
Your answer
How did you hear about WriteGirl?
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What kind of writing do you like to do? *
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What kinds of things do you like to read?
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What are some of your other hobbies and extra-curricular activities?
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Why do you want to join WriteGirl? *
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