MENTEE APPLICATION

** Please turn off the pop off blocker **
Student Section:
Last Name:*
First Name:*
Student Number:* School : *  
Grade:* Gender:


Parent Section:
First Name:* Last Name:*
Parent Phone (xxx-xxx-xxxx):* Parent Email:*


Agreement Section:

Mentee (Student) (Please read and select all boxes)*

Parent (Please read and select all boxes)*

As a part of the mentoring program, your child will have an opportunity to attend Super Saturday events and participate in one on one or small group outings with their mentor. In the event that you need help with transportation, do you give permission to your child's mentor to transport them? * :

I understand that entering my first and last name below represents my electronic signature to this application. (Parent)*

I understand that entering my first and last name below represents my electronic signature to this application. (Student)*