Inner City Youth Charitable Foundation (ICYCF) Mentee Application
Please answer EVERY question to the best of your ability.
The Basics
First Name *
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Gender
Are you a US citizen?
Phone number *
Your answer
Address *
Your answer
Email address *
Your answer
Home
Who lives with you in the home where you reside?
What is the phone number for your primary parent/guardian?
Your answer
What is your primary parent/guardian's address?
Your answer
What is your primary parent/guardian's email address?
Your answer
What is the best way to contact your parent/guardian?
Highest level of education completed by your father
Highest level of education completed by your mother
What is your father's current occupation?
Your answer
What is your mother's current occupation?
Your answer
If you live with a guardian, what is her/his occupation?
Your answer
How many people are living in the household including yourself?
Your answer
How many incomes are paying for your family's needs?
Your answer
Have you ever had a job outside of your home?
If so, what was the job and how long did you work?
Your answer
Do you help pay for your family's needs or are you responsible solely for your own expenses?
Your answer
Church
Do you regularly (2+ times a month) attend church services?
Where do you attend church services (regularly or otherwise)?
Your answer
How long have you been attending church services there?
Your answer
High School
Select the option that best describes your high school (or the one you will be attending).
What is the name of your high school?
Your answer
What grade will you be in during the 2018-2019 school year? *
What is your current GPA?
Your answer
If you have taken the exam(s), what is your highest ACT / SAT score?
Your answer
How did you hear about the ICYCF Mentorship and Scholarship Program?
Your answer
Short Essay
Why would you like to participate in the ICYCF Program?
Make your remarks as clear and complete as possible - approximately 100 to 400 words.
Your answer
ICYCF Mentoring Match
If accepted to the Inner City Youth Charitable Foundation’s Mentorship and Scholarship Program, you will receive a mentor. A mentor is a student who is a friend, a resource, and a guide for you as you start your journey to college. The information below will be used to match you with a mentor. This information will be shared with your mentor. The previously entered application information will be held confidential. The mentor matching survey has no bearing on your acceptance into the ICYCF Student Scholarship Program.
What extracurricular activities do you enjoy?
List the names of activities in which you are involved.
Your answer
What would you like your mentor to know about you?
Your answer
What do you hope to learn from your mentor?
Your answer
Please check the "Yes" option here if you are willing to commit to the ICYCF Mentorship and Scholarship Program requirements provided to you by a member of the ICYCF Board, including regular weekly meetings with your mentor. *
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