STS Mentoring Program Questionnaire
First and Last Name
Your answer
Phone Number
Your answer
Email
Your answer
Address
Your answer
Race and Ethnicity
Gender
City/State/Zip
Your answer
Student Cellphone Number
Your answer
Student Email
N/A if you don't have an email
Your answer
Name of School Counselor
Your answer
Parent/Guardian Name
Your answer
Parent/Guardian Email
Your answer
Parent/Guardian Cell number
Your answer
Age
Your answer
Year in school
How did you learn about STS Mentoring?
Are workshops scheduled on a good day (Saturdays)?
Are workshops scheduled at a good time (Mornings)?
Are you involved in any extracurricular activities?
If yes, please list
Your answer
Which components you believe will be most helpful?
Required
Do you plan to go to college?
Is yes, select type
If yes, where are you planning on attending College?
Intended Major:
Your answer
Desired Career
Your answer
What was your latest GPA?
Please provide Q4 report card at interview
Your answer
What are your hobbies? Things you like or might be interested in?
Your answer
What’s one thing that makes you different?
Your answer
What inspires, motivates, and encourages you?
Your answer
What’s something that you would like to see in Memphis, that doesn't currently exist in Memphis?
Your answer
What is your favorite Movie?
Your answer
What are you expecting out of the STS Mentoring Program?
Your answer
Have you ever had a mentor?
Your answer
Are you excited about having a mentor?
Your answer
If you had a chance to change one thing about yourself, What would it be?
Your answer
What impact do you want to leave on the world?
Your answer
Do you have a relationship with God?
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