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* 1. Last Name:

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* 2. First Name:

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* 3. Name of High School:

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* 4. Current Grade:

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* 5. Career Goals:

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* 6. List 3 Areas of Interest:

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* 7. This is a 32-hour mentorship program.
Please indicate which times M-F you are available to meet with your mentor:

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* 8. Best Contact Number:

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* 9. Email:

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* 10. The best method to contact you is by:

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* 11. How would you prefer to communicate with your mentor?
Please check all that apply:

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* 12. What is the #1 thing you would like to get out of your mentorship?

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* 13. In 3 years' time, where do you see yourself?

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* 14. If you had to describe yourself (select all that apply):

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* 15. Your top 3 passions are:

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* 16. Describe your ideal mentor:

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* 17. What does mentorship mean to you?

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