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Mentee Application

Mentee Information

First Name *This question is required.

Last Name *This question is required.

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

calendar

Gender *This question is required.

Street Address *This question is required.

Apt/Suite

City *This question is required.

State *This question is required.

Zip *This question is required.

Primary Phone Number *This question is required.

Type *This question is required.

Secondary Phone Number

Type

By opting in I agree to Urban Hope Indy's terms and conditions and privacy policy.
I also consent to Urban Hope Indy to send SMS related to my mentoring activities.
Message frequency varies for HELP text us at (317) 982-5090 to unsubscribe text STOP standard messages and data rates my apply. *This question is required.

Ethnicity *This question is required.

If you said other, please specify.

Preferred language/s *This question is required.

Arabic
Chinese (Mandarin, Cantonese)
English

French
Korean
Somali

Spanish
Swahili
Tagalog

Vietnamese
Other

If you said other, please specify.

Grade *This question is required.

School *This question is required.

Interests *This question is required.

Arts/crafts
Board games
Building/construction
Computer games
Concerts
Cooking
Dance

Movies
Museums
Music
Outdoor activities
Playing an instrument
Reading
Robotics/STEM

Shopping
Singing
Sports
Theater (plays)
Travel
Walking/hiking
Other

If you said other, please specify.

Mentee is living with *This question is required.

If you said other, please specify.

Does the mentee have a church they attend? *This question is required.

Name of Church *This question is required.

Has the mentee ever been involved with the Juvenile Justice System? *This question is required.

Has the mentee qualified for government assistance in the last 24 months, i.e., Food Stamps, WIC, Housing, TANF/AFDC, etc.? *This question is required.