Thank you for your interest in being matched with a mentor through JBBBSLA'S MAIN Coach Program!

The Make An Impact Now (MAIN) Coach Program matches motivated high school juniors and seniors for one year with a mentor who supports their goals and enhances their knowledge about college and careers.

In order to qualify for the program, you must:
* Be current or incoming 11th or 12th grade high school student.
* Commit to working with your MAIN Coach for one year.
* Be willing to check in either virtually (via phone call, video call, text, or email) or in-person with your MAIN Coach at least once a month.

Your responses to our Student Application will give us with more insight on your interests and preferences so we can provide the most optimal match to a MAIN Coach. If we find the right match for you, you will receive additional information and waivers to the email address you provide below. 
Questions? Email Zoe Gerowitz at zgerowitz@jbbbsla.org.

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* 1. Full Name

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* 2. Preferred Nickname

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* 3. Mobile Number

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* 4. Email (please share an email you check frequently)

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* 5. Home City, State, Zip Code

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* 6. Current High School

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* 7. Grade Level

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* 8. Age

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* 9. Gender

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* 10. Ethnicity

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* 11. Do you affiliate with any of the following religious identities? 

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* 12. What is your household income?

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* 13. Parent/Guardian Full Name

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* 14. Parent/Guardian Email

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* 15. Parent/Guardian Mobile Number

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* 16. Are you a first-generation college going student? (Note: We define first generation as a student whose parents did not obtain a 4-year/bachelor's degree in the United States)

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* 17. What other JBBBSLA Programs have you participated in? (check all that apply)

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* 18. Why are you interested in having a mentor? (check all that apply)

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* 19. By participating in JBBBSLA's MAIN Coach Program, I hope to...

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* 20. Are you currently participating or have participated in a mentoring program?

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* 21. If you answered YES to the question above, please list the name of the program(s) and when/how long you have been involved:

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* 22. Do you prefer to be matched with a male or female mentor?

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* 23. Rank your preferred methods of communication with your mentor, with 1 being your most preferred method:

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* 24. What topics do you hope to explore with your mentor during your check-in sessions? (check all that apply)

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* 25. Personal Insights (answer  at least 3 of the below questions)

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* 26. Academic Highlights

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* 27. Write a brief biography about yourself. Feel free to share your grade level, school, interests, extra-curriculars, goals etc. The more details you share, the more your MAIN Coach can learn about you before your first meeting.

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* 28. Is there any additional information you think we should know to provide the most optimal match to a mentor? (i.e. scheduling conflicts, specific preferences for a mentor, etc.)

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