EmailMe Form - TeenWorks Mentee Application

Name of Applicant *

First Last

Preferred Nickname (if any)

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone (where can you be reached by phone?) *

### - ### - ####

Favorite color:

Favorite Music:

Favorite Food:

Favorite Animal:

Favorite Candy:

Favorite Place to Visit:

Favorite School Subject:

Favorite Sports:

Favorite Hobbies or Past-time activities:

Where do you see yourself in 5 years?

If you could pick any career, what would it be?

What have you always wanted to do that you have not done before?

What do you feel your strengths are?

If you could have three wishes, what would they be?

Fill in the blanks below:

Wish No. 1

Wish No. 2

Wish No. 3

Check all the words that describe your personality: *

Anything else you would like to tell us?

Youth Agreement

By signing and submitting this document, I understand that I will be participating in the TeenWorks youth mentoring program. I agree that I am open to meeting a new caring adult and will be open to getting to know them. I understand that it is normal to feel a little apprehensive or uncomfortable at first; however, if I do not feel comfortable with my mentor, I understand that I am not "stuck" with him or her.

I further agree to the following:

1. I will do my best to keep all my scheduled get-together times with my mentor.
2. I will call my mentor if I can't meet with him or her.
3. I will tell my parent and/or my oversight person at TeenWorks if I have any problems and/or do not feel comfortable with my mentor.
4. I will remain open to having new people in my life.

Signature (use your finger or a stylus to sign, even if it looks odd). *

Clear

Today's Date *

MM / DD / YYYY

Email