College & Career Readiness Mentee Application

Please complete and submit the mentee/student application to be enrolled in Scholar Career Coaching Mentorship Program.

Contact Information

First Name *This question is required.

Middle Name

Last Name *This question is required.

Primary Phone Number
(xxx-xxx-xxxx) *This question is required.

Personal Email Address (NOT your school assigned email) *This question is required. This question requires a valid email address.

Street Address *This question is required.

Apt.

City *This question is required.

Zip *This question is required.

If you said Other, please specify.

Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Select your age group *This question is required.

If you said Other, please specify your age here *This question is required.

My Gender Identity *This question is required.

If you use a different description for your racial identity, please specify here:

If you do not find your ethnic identity listed, please specify your ethnicity here: *This question is required.

If Other, specify.

Do you require any disability-related accommodation(s) for you to effectively participate in any in-person or virtual programming OR for you to utilize any resources offered by Scholar Career Coaching? *This question is required.

If Yes, please specify here: *This question is required.

Are you an ESL (English as a Second Language) student or enrolled in ESOL? *This question is required.

Is English your first language? *This question is required.

If No, what is your first language?

College & Career Readiness Mentee Application

About Me