Queens Building Queens Mentee Application

Queens Building Queens is a youth mentoring program for teenage girls between the ages of 13-18. Our goal is to strengthen your youth's academics, social skills, mental health, financial literacy and self-esteem. During your child's journey in our program they will transition from a Rosebud (8th-11th) to a Rose (graduating highschool seniors). Once your child has completed our program they will be honored at our annual debutante ceremony.

To apply to be in the Mentoring Program, please fill out the application below. Once you submit the application, a Queens Building Queens staff member will reach out with the next steps.

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Mentee’s First and Last Name *
Date of Birth *
Name of current school *
What is the mentee’s projected highschool graduation year?  *
Mentee’s phone number *
Mentee’s email address *
Preferred language *
Please list any allergies:
Are there any medical, physical, or emotional limitations or considerations that we should know about to create a better mentoring experience?
 *
Your child will be contacted at least once a week by a mentor. Please put all available times below
Morning
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Parent/Guardian name: *
Street Address (Please include city, state and zip code) *
Parent/Guardian Home/cell phone: *
Parent/Guardian Email: *
Emergency contact full name (other than a parent/guardian) *
Emergency contact phone number *
Please list the names and phone numbers of peope who are allowed to pick up the youth other than the parent/guardian:
Do you (mentee) agree to complete 20 community service hours annually? *
Why do you want to be apart of our mentorship program? *
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