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Apply to be matched to a mentor

This is the youth application form.

This form is for kids and teens to apply to be matched to a mentor. You can also refer a youth or apply to be a mentor.

Some of the following questions are very personal in nature. These questions will help the program know your child completely and be able to match them with a mentor who will complement their personality and needs as closely as possible.

It’s best to complete this form with the child or teen and parent or caregiver together.

This should take about 15-25 minutes. You will need:

  • A recent photo of yourself
  • Emergency contact information
  • Contact information for all participating parties, and
  • A brief medical history.
  • We’ll also ask about interests and hobbies.

You can save a copy of this form anytime using the “Save and Continue” link.

Youth application form

Step 1 of 4

Child or teen's information

Name
Address
MM slash DD slash YYYY
Leave blank if there is no number.
Leave blank if there is no number
Leave blank if there is no address

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