Mentor Me Learning Leadership Program Inquiry Form
Congratulations on being a step closer to being a peer leader in your community. By participating in our program you will get to make a real impact in the community and effectively share your interests and talents in the real world. We look forward to learning more about you so that we can design a mentorship and activities suited just for your needs.

Please fill out the form below and we will get back to you with more information.

If you have further questions, please email our Program Director, Ashley Dos Santos at
First and Last Name of Person Filling Out Application *
This could be the student themself, a parent, friend, teacher, etc.
Relationship to applicant *
This could be "self" (meaning you are the applicant), parent, teacher, friend, etc.
Email of Person Filling Out Application *
Phone Number of Person Filling Out Application *
First and Last Name of Student *
This would be the name of student that is applying to the program
Student Email *
Student Phone Number *
City of Residence *
Student Age *
Applicant's School and Grade Level *
Why do you want to participate in the program? Or Why are you recommending the applicant to this program? *
What are your strengths? Or what do you consider to be strengths of the applicant? *
List at least three strengths
What are your interests/hobbies? Or what do you consider to be the interests/hobbies of the applicant? *
Be honest here and list at least three interests
What current activities are you (the applicant) currently involved in during a normal week? *
Describe what your weekly schedule is like
Are you interested in applying for a financial aid? *
Scholarships are based on the applicant pool for each program since we have a limited amount of dollars to award.
Do you have any questions about the Program or about Mentor Me?
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