Mentee Application Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

National Coalition of 100 Black Women, Inc. Queen City Metropolitan Chapter

Student Name *

First and last name

Parent Name *

Address *

Parent Phone Number *

Student Phone Number *

Student Email *

Parent Email *

Do you prefer to receive important BB2S information via: *

Text

Both

School & Grade Level *

Age & Birthday *

What is your favorite academic subject(s)? *

What clubs, activities, community service or sports do you currently participate in? *

What do you like to do in your spare time? *

What are three words that best describe you? *

What do you plan to study after high school? What post-secondary institutions would you like to attend? *

What are your future career interests and goals? *

What do you hope to gain from being a participant in this program? *

Is there anything else you would like to share about yourself that may help us determine the best Mentors for you? *

All participants are required to attend monthly activities during the months of January - June. To ensure that you gain the most from BB2S you will need to make every effort to attend and fully participate in these activities. *

Yes

Will you try your best to attend every monthly group activity?

Will you make every effort to meet/complete all BB2S tasks/assignments?

Will you respond to messages from Mentors in a timely manner?

Digital Signature of Parent and Student *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Weebly Email Service. Report Abuse

Forms