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Mentee Referral Form

Mentee Information

Has the parent been told that a referral to Mentor Me is being made for their child? *This question is required.
If the parent has not been asked, please call or ask your agency social worker to call the parent/guardian and ask the parent if they would like to learn more about the program.  

If the parent/guardian does not want to hear more about the program, the child cannot be referred 
Child's Information
This question requires a valid date format of MM/DD/YYYY.
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Child's Gender *This question is required.
Child's Pronouns *This question is required.
What language does the child speak? *This question is required.
Does the child have any hobbies or special interests?
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