Girl Tyme Mentee Application
Please complete application. If you have any questions or concerns, please email GirlTymeMentoring@Gmail.Com
Email address *
Name *
First and last name
Email *
Address *
Phone number *
Date Of Birth *
MM
/
DD
/
YYYY
Race *
Attending School *
Grade *
Current GPA:
Parent/ Guardian *
Parent/ Guardian (Telephone, Address and Email) *
What are your hobbies/ interest *
What are some of your personal qualities/ talents? *
What are your expectations from Girl Tyme? *
How did you hear about the program? *
Are you willing to participate in monthly activities? *
Are you willing to commit to Girl Tyme for a year? *
Please explain why you are interested having a mentor. *
What qualities are you looking for in a mentor?
Emergency Contact: *
Please sign and date. This affirms that all above information is true to the best of your knowledge. *
Parent or Guardian Signature if under 18 *
Girl Tyme Mentoring Program Consent Form
Please check in the boxes provided after reading to show that you understand each provision. Please feel free to ask any questions regarding this form.
*
Required
Please Sign and Date *
Parent/ Guardian Signature if under 18 *
Submit
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