Mentee Application Form
National Coalition of 100 Black Women, Inc. Queen City Metropolitan Chapter
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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: *
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
No
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
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