INFORMATION ABOUT STUDENT

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* 1. Student FIRST name

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* 2. Student LAST name

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* 3. Who is filling out this form?

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* 4. Student telephone contact information (Please enter ONLY the student's cell phone number, not a parent cell phone)

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* 5. Student email contact information (Please enter ONLY the student's email, not a parent email):

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* 6. What's the best way to get in touch with student?

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* 7. What High School does student attend?

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* 8. Year student will graduate High School

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* 9. What pronouns does student prefer to use?

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* 10. Student's nationality/race

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* 11. How did your family first hear about Mentors 4 College?

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* 12. If student has a sibling who was mentored through the Mentors 4 College program, please tell us this sibling's name

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* 13. What zip code does student live in?

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* 14. Does student have access to the internet, plus a tablet, laptop or desktop computer outside of school hours, during evenings and weekends (access can be at home, at a library, at a neighbor's or relative's, at a coffee shop, etc)?

 
 14% of survey complete.

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