+Mentor Enrollment Form

First name

Last name

Preferred pronouns

Email

Phone

Birthday

Day

Month

Year

Current Year Level

Parent/Guardian name

Parent/Guardian phone

Parent/Guardian email

Which program are you interested in?

What are your expectations/goals that you hope to acheive in this program?

What are your specific areas of interest or strengths you would like to focus on?

Have you participated in any mentorship or personal development programs before? If so, please provide details.

Do you have any specific challenges or areas where you would like additional support?

Are you able to commit to attending regular sessions and engaging in program activities?

Yes

No

Do you have a preferred schedule or time of day for sessions?

Yes

No

What days and times would you prefer your sessions to be scheduled?

Do you have access to a stable internet connection and a device for virtual sessions?

Yes

No

Do you grant permission for The Positive Mentor Programs to share your contact information with your assigned mentor?

Yes

No

Is there any additional information or special accommodations that you would like us to be aware of?