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 ashley@mentormelearning.com
First and Last Name of Person Filling Out Application *
This could be the student themself, a parent, friend, teacher, etc.
Your answer
Relationship to applicant *
This could be "self" (meaning you are the applicant), parent, teacher, friend, etc.
Your answer
Email of Person Filling Out Application *
Your answer
Phone Number of Person Filling Out Application *
Your answer
First and Last Name of Student *
This would be the name of student that is applying to the program
Your answer
Student Email *
Your answer
Student Phone Number *
Your answer
City of Residence *
Your answer
Student Age *
Your answer
Applicant's School and Grade Level *
Your answer
Why do you want to participate in the program? Or Why are you recommending the applicant to this program? *
Your answer
What are your strengths? Or what do you consider to be strengths of the applicant? *
List at least three strengths
Your answer
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
Your answer
What current activities are you (the applicant) currently involved in during a normal week? *
Describe what your weekly schedule is like
Your answer
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?
Your answer
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