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Mentee Application
Name
Preferred Name (If other than First Name)
Address
Phone
Email
My contact preference is (Check all that apply):
In Person
Email
Phone
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My Age Range
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What age range do you hope your mentor to be? (Check all that apply)
Young Adult
Adult
Senior Adult
Marital Status
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Spouse's Name, if married
Household Type
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And for how long?
Number of Children
Number of Grandchildren
Are you a church member?
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Do you atted church regularly?
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No
At Parkside
Another Church
Do you have a favorite Bible verse? If so, add here:
Do you work outside the home?
Yes
No
What is/was your occupation?
How long?
What are your hobbies/interests?
Have you ever been a mentee before?
Yes
No
If so, when?
Do you have any specifc area of need?
How would having a mentor make a difference in your life?
Additional Comments
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