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Sign Up to request an Mentor or to have a Mirror Me Session at your school or business!
Email address *
Please Enter the Parent's Full Name *
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Are You Requesting A Mentor, Mirror Me Session, or Both? *
If you're requesting a mentor please answer the questions below. If you are requesting Mirror Me Session email us at info@mirrorme.org. Please include location, session date (s), and times. Someone from the MMI team will get back to you within 48 hours.
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Are you the parent or the child? *
What is the child's full name? *
Your answer
What school does the child attend? *
Your answer
Photos- I consent photos of the above named child, if taken, to be used for Mirror Me Image's promotional use. If yes, please type the parent name below. *
Your answer
Waiver- I hereby name harmless Mirror Me Images, its Founders, directors, and staff for any injury or loss to any persons; lost or damaged items that may occur during the above named child's participation in any programming or mentoring. If yes, type the parent name below. *
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The following questions are for the child. Is the child present?
What are some of your career goals? *
Your answer
Where do you see yourself in 5 years? *
Your answer
In what areas do you feel you need the most assistance?
Your answer
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