Forever Mentoring Program Enrollment Form

In order that we may best match you with a mentor/mentee please answer the enrollment form below as completely as possible.

* Indicates required field.

Please check one:*

I am a mentor seeking a student mentee.I am a student mentee seeking a mentor.

Mentor/Mentee Full Name*

First NameLast Name

Date of Birth*

MonthDayYear

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail Address*

Phone Number*

Area CodePhone Number

Academics

	Motivation	Study Habits	Test Taking	Time Management	Tutoring
4
3
2
1
0

College Preparation

	Test Preparation	Financial Aid	Scholarships	College Selection	Community Involvement
4
3
2
1
0

Self Improvement

	Confidence Building	Leadership Skills	Communication Skills	Networking	Prioritizing
4
3
2
1
0

Please indicate other areas you would like to explore.

In which specific academic area(s) would you like to explore through the mentoring program? Please indicate no more than 2 areas.

(For example: Mathematics and AP American History)

In which specific occupational area(s) would you like to explore through the mentoring program? Please indicate no more than 2 areas.

(For example: criminal law and video production)

Mentors Only: What is your current college major or occupation?

This section should be completed by the Mentor or the Mentee. Mentors should explain why you feel well qualified to serve as a student mentor in the above area(s)? Mentees should explain how he or she hopes to benefit from participating in the Forever Mentoring program.*

Please attach a current resume (no more than three pages) including a list of 3 or more references with contact information (name, email, and phone) for each reference. The resume will be shared with the FBAA Student Mentee as part of your profile. To be completed by the Mentor candidate only.

Upload a File

We will try our best to match you with a student mentee using the information you provided. Would you also be interested in other volunteer opportunities with FBA? If yes, please indicate how you would like to contribute.

Helping at a FBA Special EventSpeaking at a FBA Special EventProviding an in-kind donation (such as space, food, prizes)Participating as a member on the FBA Board of DirectorsNo thanks.

Mentor Authorization and Disclaimer:I certify that the information I have given on this enrollment form is true and complete. I understand my failure to provide complete, accurate and truthful information on the application will be grounds to deny or withdraw my admission or dismiss me after enrollment. I hereby acknowledge that providing the information above is voluntary, is requested by the organization solely for admission to the Forever Mentoring program and is required only to provide a personal identifier for the internal records of this organization. I hereby acknowledge that the organization may verify the information set forth herein from sources and references I have provided. I also acknowledge that as a safety precaution information set forth herein may be used by the organization to conduct public criminal searches. For more information about the Forever Bloom Alliance and its programs visit foreverbloom.org or email info@foreverbloom.orgMentee/Parent Authorization and Disclaimer:I hereby give my child permission to participate in the FBA Forever Mentoring Program. I certify that the information I have given on this enrollment form is true and complete. I have read the Forever Mentoring Safety and Procedural Guidelines provided by the organization outlining my child’s participation in the program. Understand that I must first agree to any mentor-mentee matching set by the organization and that communication between my child and a potential mentor may only take place on my initiative.

Please indicate below that you have read and either "Agree" or "Disagree" with the Authorization and Disclaimer statements above.*

I AgreeI Disagree

Mentor/Mentee: Please confirm the statements in the authorization and disclaimer by typing in your full name in the electronic signature area below. A parent must sign and provide an email if the mentee is under 18. Information contained in this form will not be shared with a potential mentor without a parent authorization indicated by an electronic signature and email address.*

Parent E-mail (For mentees under 18 only)

Forever Bloom Alliance

Forever Mentoring Program Enrollment Form

1. Mentor/Student Mentee Information:

2. Skill-based Areas of Interest

3. Academic and Career-based Areas of Interest

4. Mentor/Mentee Motivation Statement

5. Resume' and References (Mentors Only)

6. FBA Volunteer Opportunities (Mentors Only)

7. Authorization and Disclaimers

8. Electronic Signature