Project MotiVATe: Mentee Applicant Information
In order for a potential mentee to be considered, students must be:

• Between the grades of 8th to 11th
• Vietnamese-American
• In need of assistance to develop academic, social and cultural skills
Full Name *
Gender *
Date of Birth *
Country of Birth *
Street Address *
City *
Zip Code *
High School *
Year/Grade in School
Extracurricular Activities and Hobbies
Mother's Name *
Mother's Email Address
Mother's Home Phone *
Mother's Cell Phone
Mother's Occupation *
Father's Name *
Father's Email Address
Father's Home Phone *
Father's Cell Phone
Father's Occupation *
Family Income *
How many people live in your household? *
How many siblings does your son/daughter have, and what are their ages & genders? *
Has your child ever been involved in disciplinary issues at school? If yes, please describe. *
Has your child been diagnosed with any learning disability (ADD, ADHD, etc.)? If yes, please describe. *
To your knowledge, has your child ever used drugs or alcohol? *
Who is filling out this application (Mentee, Mom, Dad, Sister, Counselor, etc)? *
When are you available for an interview (evenings, weekends, etc)? *
How did you hear about Project MotiVATe? *
Additional Comments
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