MENTORS 4 COLLEGE STUDENT DATA FORM (V.25A1) Survey

1.Student FIRST name(Required.)

2.Student LAST name(Required.)

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

Student cell phone number

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

Student PRIMARY email address (DO NOT use your school district email address! Some districts block our emails since we're outside the district.)

5.What High School does student attend?(Required.)

6.Year student will graduate High School(Required.)

8.Student's nationality/race(Required.)

9.How did your family first hear about Mentors 4 College

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

11.What zip code does student live in?(Required.)

MENTORS 4 COLLEGE STUDENT DATA FORM (V.25A1)