Mentee Candidate Form

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* 1. Please enter your contact information below

Name

School he attends

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Parent Email Address

Parent Phone Number

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* 2. Has he ever had a mentor?

Yes

No

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* 3. In what ways do you want the mentor to impact him?

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* 4. List the names, ages, and school attended of other mentee candidates if more than one