Y Mentee Interest Form
Thank you for your interest in enrolling your child in a Y mentoring program. All Y mentoring programs match adult volunteers to young people ages 6-18. We provide a complimentary Y membership for the families of our mentees so they can participate in the many fun and enriching opportunities at the Y.
Please complete the form below so we can identify the mentoring program that's best suited to your child's needs. A member of our Y mentoring team will contact you within two business days to confirm receipt of your application and discuss next steps..
Parent/Guardian First Name
Parent/Guardian Last Name
Child's First and Last Name
Child's Date of Birth
Parent/Guardian Street Address (Include City, State)
Parent/Guardian Email Address
Best phone number to reach you
Successful mentoring relationships can range from 8 weeks to 1 year. How much time can you commit your child to meeting with their mentor?
1 year or more
How many times a month are you willing to ensure your child meets their mentor?
2-3 times a month
4 times a month
Do you anticipate a major life transition (marriage, job change, birth of a child, first year of college, etc.) within the next 12 months?
Would you prefer one-to-one mentoring in the community or at a Y center, or group mentoring at a Y center?
One-to-one mentoring in the community (transportation provided by the mentor)
One-to-one mentoring at a Y center (transportation not provided)
Group mentoring at a Y center (transportation not provided)
Often times mentees may be working through personal matters. From the list of options below, please check all areas that apply to your child.
Mental Health Diagnosis
Alcohol or Drug Use
Conflict with Authority
None of the above
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This form was created inside of Y in Central Maryland.