Girls LEAP Mentee Application Form 2022-2023
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By completing this form, you are giving your child permission to participate in Girls L.E.A.P. mentoring program.

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Student’s First Name *
Last Name *
Student’s Date of Birth *
Student’s Ethnicity (optional)
Home Address where student lives most of the time (include apartment number if applicable) *
Student’s grade level 2022-2023 *
Student's school (2022-2023)
Student Challenges (Please check all that apply.) *
Please list any goals for your student
Please list any other important information about your student
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