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Mentee Application Form
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BRIDGING THE GAP OF AMERICA, INC.
MENTEE APPLICATION FORM
Mentee First Name:
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Mentee Last Name:
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Date of Birth:
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Gender Identity:
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Male
Female
Ethnicity/Race:
Black or African American
White
Hispanic or Latino
Other
Address:
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Parents / Guardians Name:
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Parents / Guardians Email:
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Phone Number:
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Grade in School / Major:
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Name of School:
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Religious/Spiritual Ideology (if any)
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Languages (please indicate level of proficiency):
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What brings you to the Mentoring Program?
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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.,)
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Please list a few of your interests and activities on and off-campus.
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Anything else you want us to know in order to provide you with a better match:
How did you hear about the Mentoring Program?
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Google or other search
Word of mouth
Article or blog post
Social media (Facebook)
Other