Skip to content
CAHDRE Mentee Information
Background / Demographics
*
1.
Name
(Required.)
*
2.
Phone
(Required.)
*
3.
Email
(Required.)
*
4.
Home address
(Required.)
*
5.
Sex
(Required.)
Female
Male
*
6.
Age
(Required.)
*
7.
Race/Ethnicity
(Required.)
*
8.
List the language(s) you MOST often use at home
(Required.)
9.
Facebook name
10.
MySpace name
