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Mentee Application

Welcome

Thank you for your interest in enrolling your child to benefit from a volunteer Mentor with Companions for Children. After submitting the information below, our staff will be in contact to ensure eligibility and to complete the enrollment process.

What program are you applying to? *This question is required.

Child's Information

First Name *This question is required.

Middle Name *This question is required.

Last Name *This question is required.

Preferred Name (if different from above):

Gender *This question is required.

Pronouns *This question is required.

Ethnicity *This question is required.

If you said other, please specify. *This question is required.

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

calendar

Child's School *This question is required.

If you said other, please specify. *This question is required.

Child’s Grade (if summer, use upcoming grade) *This question is required.

Does the child have their own phone? *This question is required.

Child's Phone Number *This question is required. Please provide a 10-digit phone number including area code.
Enter numbers only. Formatting such as dashes will be added as you enter your phone number.

Check Yes to Opt In to receive text messages *This question is required.

Has the child ever been involved with the police of juvenile justice system? *This question is required.

Please provide dates and details. *This question is required.

Does the child have a parent/guardian who is currently incarcerated or has been in the past? *This question is required.

Please provide dates and details. *This question is required.

Tribal Affiliation *This question is required.

What tribe? *This question is required.