Mentee Application (To Be Completed by the Parent/Guardian) Youth's Name* First Last Date* Month Day Year Parent/Guardian Name* First Last Relationship to Youth* Mother Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Email Date of Birth* Month Day Year Age* Gender* Male Female Ethnicity White Hispanic African American Asian Name of School* Grade* Emergency Contact Name* First Last Emergency Contact Number*Please list all members of your household.Name Gender Male Female Age Relationship to Applicant HiddenName Gender Male Female Age Relationship to Applicant HiddenName Gender Male Female Age Relationship to Applicant HiddenName Gender Male Female Age Relationship to Applicant HiddenApplication QuestionsPlease answer all of the following questions as completely as possible.Why do you/your child want to participate in a mentoring program?*Is your child available to attend mentoring at least once a week for a minimum of one year? Please explain any particular scheduling issue.*Describe your child’s school performance including grades, homework, attendance, behaviors, etc.*Is your child currently having any problems either at home or school?*Has your child experienced any traumatic events (i.e., death in the family, abuse, divorce)? If yes, please provide details.*Can you provide any additional background information that may be helpful to Blue Sky Ranch in mentoring your child?*CommentsThis field is for validation purposes and should be left unchanged.
