Student’s Full Name *

First Name

Last Name

Full Name

First Name

Last Name

Parent/Guardian Phone Number *

(###)

###

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Best Days for Sessions *

Please select all the days your child is available for mentorship sessions. This helps us match them with someone who has a similar schedule.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Best Times for Sessions *

Please select all the times your child is available for mentorship sessions. This helps us match them with someone who has a similar schedule.

Weekdays (Mon–Fri): Evening (4 PM – 8 PM)

Weekends (Sat–Sun): Morning (9 AM – 12 PM)

Weekends (Sat–Sun): Afternoon (12 PM – 4 PM)

Parent/Guardian Consent *

I consent to my child’s participation in this program

Yes