AGBU GenNext Mentorship Program X GUSD- Referral

Staff Referral

AGBU Generation Next has partnered with Glendale Unified School District to help the youth through a one-to-one mentoring program. GenNext aims to create healthy communities by bringing together teenagers and caring adult volunteer mentors who can serve as guides through the difficult journey of adolescence. If you would like to refer someone, please fill out the form below.* Mentorship program is open to high school students*

Question Title

* 1. Staff Member Information:

Staff Member's Full Name

Email Address

Phone Number

Question Title

* 2. I am a:

Counselor

Teacher

Principal

Other

Question Title

* 3. I am referring a:

Mentor (Mentors are 21 and over)

Mentee (Open to High School Students)

Question Title

* 4. I Am Referring Please put "N/A" if you do not have information

Student Name

School

Email Address

Phone Number

Question Title

* 5. Student's Grade Number

Question Title

* 6. Parent Information Please put "N/A" if you do not have information

Parent Name

Email Address

Phone Number

AGBU GenNext Mentorship Program X GUSD- Referral

Staff Referral

Question Title

* 1. Staff Member Information:

Question Title

* 2. I am a:

Question Title

* 3. I am referring a:

Question Title

* 4. I Am Referring **Please put "N/A" if you do not have information**

Question Title

* 5. Student's Grade Number

Question Title

* 6. Parent Information **Please put "N/A" if you do not have information**

Question Title

* 7. Comments/Questions

* 4. I Am Referring Please put "N/A" if you do not have information

* 6. Parent Information Please put "N/A" if you do not have information