Mentee Application (To Be Completed by the Parent/Guardian) Youth's Name* First Last Date* MM DD YYYY Parent/Guardian Name* First Last Relationship to Youth*MotherAddress* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Email Date of Birth* MM DD YYYY Age*Gender*MaleFemaleEthnicityWhiteHispanicAfrican AmericanAsianName of School*Grade*Emergency Contact Name* First Last Emergency Contact Number*Please list all members of your household.NameGenderMaleFemaleAgeRelationship to ApplicantNameGenderMaleFemaleAgeRelationship to ApplicantNameGenderMaleFemaleAgeRelationship to ApplicantNameGenderMaleFemaleAgeRelationship to ApplicantApplication 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?*PhoneThis field is for validation purposes and should be left unchanged.