Douglas S. Freeman High School 2012 Mentee Application

DOUGLAS S. FREEMAN HIGH SCHOOL 2012 MENTEE APPLICATION

Please answer all questions.

Personal Information:

Name______Gender  Male First Middle Last  Female

Address ______Street City State ZIP

Home phone ______Student E-mail address ______

Father/Guardian’s name ______

Work phone ______Occupation ______

Mother/Guardian’s name ______

Work phone ______Occupation ______

Parent/Guardian E-mail address ______

Emergency contact ______Home phone ______

Work phone ______Relationship ______

School Information:

1. Grade level ______

2. What is your schedule? 1st ______2nd ______3rd ______4th ______Study Block A B C D Please circle which Study Block you have. Lunch Block A B C D Please circle which Lunch Block you have. 5th ______6th______7th______

3. What are your favorite subjects? ______

Continued on back Courtesy of and adapted from an application from the California Governor’s Mentoring Partnership.

2012-2013Application Your Interests:

1. What are your hobbies and interests? ______

2. Do you participate in any extracurricular activities outside of school (e.g., Boy/Girl Scouts, youth programs)? If yes, explain: ______

3. What is your career goal or what types of careers interest you? ______

4. Do you plan on attending college after you graduate?  Yes  No

5. What would you hope to gain from having a mentor? ______

6. If you could volunteer to help someone or a particular group, what would you do? Why? ______

Favorites:

What is your favorite...? Food ______Color ______Book ______Movie ______Music Group ______Song ______Person ______Place to visit ______Things to do in your free time ______

Match Information:

What days of the week are you available to participate? (check all that apply):  Monday  Tuesday  Wednesday  Thursday  Friday  Saturday  Sunday

What three words best describe you? 1.______2.______3.______

Courtesy of and adapted from an application from the California Governor’s Mentoring Partnership.

2012-2013Application