* 1. How did you hear about us?

* 2. What is the mentees name and how old is he?

* 3. What school does he attend?

* 4. What is his guardians name?

* 5. What is the guardian's best phone number?

* 6. What is the guardian's email?

* 7. What is the guardian's best physical address?

* 8. We only accept boys between the ages of 10-13 that have lost their fathers to violence, natural causes or long term incarceration. We can not accept absent/willful neglect cases at this time. Which category fits the mentees situation?

* 9. What is your child's ethnicity? (Please select all that apply.)

* 10. Explain the mentees fatherless situation. More detail, the better.

* 11. What recreational activities is your son involved in?

* 12. How many siblings of the mentee live in the same house with him and what are their ages.

* 13. Does the mentee have transportation to and from events? If not, explain. Unfortunately we can not provide transportation to and from events at this time. 

* 14. Does a male over the age of 18 live in the same house as the mentee?

* 15. Does your son know a boy that is in our program? If so, what is his name?

* 16. Will the guardian be able to commit  4 volunteer hours a month to our organization?

* 17. Please leave any comments here.

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