Mentee Application

Youth's Name*

First Last

Date*

Parent/Guardian Name*

First Last

Relationship to Youth*

Mother

Address*

Street Address City State ZIP Code

Cell Phone*

Email

Date of Birth*

Age*

Gender*

Male
Female

Ethnicity

Name of School*

Grade*

Emergency Contact Name*

First Last

Emergency Contact Number*

Please list all members of your household.

Name

Gender

Male
Female

Age

Relationship to Applicant

This field is hidden when viewing the form

Name

Gender

Male
Female

Age

Relationship to Applicant

This field is hidden when viewing the form

Name

Gender

Male
Female

Age

Relationship to Applicant

This field is hidden when viewing the form

Name

Gender

Male
Female

Age

Relationship to Applicant

This field is hidden when viewing the form

Application Questions

Please answer all of the following questions as completely as possible.

Why do you/your child want to participate in a mentoring program?*

Is your child available to attend mentoring at least once a week for a minimum of one year? Please explain any particular scheduling issue.*

Describe your child’s school performance including grades, homework, attendance, behaviors, etc.*

Is your child currently having any problems either at home or school?*

Has your child experienced any traumatic events (i.e., death in the family, abuse, divorce)? If yes, please provide details.*

Can you provide any additional background information that may be helpful to Blue Sky Ranch in mentoring your child?*

Name

This field is for validation purposes and should be left unchanged.

(To Be Completed by the Parent/Guardian)

Please list all members of your household.

Application Questions