<p> DOUGLAS S. FREEMAN HIGH SCHOOL 2012 MENTEE APPLICATION</p><p>Please answer all questions.</p><p>Personal Information:</p><p>Name______Gender  Male First Middle Last  Female</p><p>Address ______Street City State ZIP</p><p>Home phone ______Student E-mail address ______</p><p>Father/Guardian’s name ______</p><p>Work phone ______Occupation ______</p><p>Mother/Guardian’s name ______</p><p>Work phone ______Occupation ______</p><p>Parent/Guardian E-mail address ______</p><p>Emergency contact ______Home phone ______</p><p>Work phone ______Relationship ______</p><p>School Information:</p><p>1. Grade level ______</p><p>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______</p><p>3. What are your favorite subjects? ______</p><p>Continued on back Courtesy of and adapted from an application from the California Governor’s Mentoring Partnership.</p><p>2012-2013Application Your Interests:</p><p>1. What are your hobbies and interests? ______</p><p>2. Do you participate in any extracurricular activities outside of school (e.g., Boy/Girl Scouts, youth programs)? If yes, explain: ______</p><p>3. What is your career goal or what types of careers interest you? ______</p><p>4. Do you plan on attending college after you graduate?  Yes  No </p><p>5. What would you hope to gain from having a mentor? ______</p><p>6. If you could volunteer to help someone or a particular group, what would you do? Why? ______</p><p>Favorites:</p><p>What is your favorite...? Food ______Color ______Book ______Movie ______Music Group ______Song ______Person ______Place to visit ______Things to do in your free time ______</p><p>Match Information:</p><p>What days of the week are you available to participate? (check all that apply):  Monday  Tuesday  Wednesday  Thursday  Friday  Saturday  Sunday</p><p>What three words best describe you? 1.______2.______3.______</p><p>Courtesy of and adapted from an application from the California Governor’s Mentoring Partnership.</p><p>2012-2013Application</p>