Mentee Application
Email address *
Parent/Guardian's Name *
Your answer
Child's Name *
Your answer
Home Address (Address, City, County, Zip) *
Your answer
Main Phone *
Your answer
Secondary Phone
Your answer
Email Address
Your answer
Child's School and Grade *
Your answer
Child's DOB *
MM
/
DD
/
YYYY
Child's Gender *
Child's Ethnicity
Your answer
What is the primary reason for you wanting your child to have a mentor? *
Your answer
What are your child's thoughts about having a mentor? *
Your answer
Does your child have any medical conditions that might affect their participation in activities with a mentor?
What is your child's primary living situation *
Is there a person who shares custody of this child? *
Do you anticipate any significant life changes over the next year or have you had any in the past year? *
Are you receiving public assistance? *
TrueMentors Application Agreement
The information I provided on this application is true and complete to the best of my knowledge. I understand the information I have shared on this application is subject to this program's Policy on Confidentiality which I can review upon my request.

I understand the TrueMentors program is not obligated to accept, assign, or actively seek a volunteer for any child. If my child is accepted and placed on the waiting list, I understand that their placement with a volunteer is not guaranteed. My child may stay on the waiting list until the age of fifteen (15) at which time they would be removed from the waiting list.

Should my child be accepted into the TrueMentors program, I agree to release TrueNorth Community Services, the TrueMentors program, its agents, and officers from all liability concerning my child's involvement.

Clicking 'I agree' will be considered equal to a signature of agreement to the above statements.

Do you agree to the above statements? *
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