New Mindz Mentorship Program, LLC
Mentee Interest Form
Child’s Full Name
Type Answer
What are some of your daughters interest ?
What age group is your child ?
K-5
6-8
9-12
Young Adults
Current School
Parent/Legal Guardian
Contact Information
What areas is your daughter struggling the most or need a little more guidance ?
Confidence
Depression *Please Note: I am not a therapist
Building Friendships
Entrepreneurship
Body Image
Other
Has your daughter worked with a Mentor Before ?
Yes
No
What type of mentoring do you prefer for your daughter ?
1-on-1 Mentoring
Group Programs that may include other girls and facilitators
How did you hear about our mentoring program and what do you know about us?
What are you looking to accomplish for your daughter through mentoring and special programs?
Phone Number
-
Area Code
Phone Number
Name and Email Address
Submit
Should be Empty: