Mentee Application Form

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BRIDGING THE GAP OF AMERICA, INC.

MENTEE APPLICATION FORM

Mentee First Name: *

Mentee Last Name: *

Date of Birth: *

Gender Identity: *

Male Female

Ethnicity/Race:

Black or African American White Hispanic or Latino Other

Address: *

Parents / Guardians Name: *

Parents / Guardians Email: *

Phone Number: *

Grade in School / Major: *

Name of School: *

Religious/Spiritual Ideology (if any) *

Languages (please indicate level of proficiency): *

What brings you to the Mentoring Program? *

What are some criteria based off of which you would want to be matched with a mentor? Are there specific identities you would prefer in a mentor? (for example, identifies as female, a person of color, etc.,) *

Please list a few of your interests and activities on and off-campus. *

Anything else you want us to know in order to provide you with a better match:

How did you hear about the Mentoring Program? *

Google or other search Word of mouth Article or blog post Social media (Facebook) Other