Mentee Intake FormYour story matters. Start here. Name * First Name Last Name Date of Birth * Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact * First Name Last Name Phone * Country (###) ### #### Current School/College (if applicable) * Current Job(if applicable) * Education Level * High School College Graduate Other How did you hear about Girl Get Up Inc.? * Why do you want to join this mentorship program? * Career Guidance Personal Development Leadership Skills Networking Opportunities Other Select the areas you might need help from a mentor? * Confidence Building Goal Setting Resume Writing & Job Readiness Public Speaking Financial Literacy College & Scholarship Guidance Other What career fields or industries interest you? * Do you have any specific goals you’d like to achieve through mentorship? * Preferred Mentor Ethnicity * Preferred Mentor Age Range * Preferred Communication Method * Phone Email Virtual Meetings In-Person Meetings Do you have any special needs, accommodations, or considerations we should be aware of? * Is there anything else you'd like us to know? * Consent & Agreement * By printing my name below, I acknowledge that all information provided is accurate. I understand that participation in the mentorship program in voluntary, and I agree to actively engage in mentorship sessions and abide by program guidelines. I acknowledge Thank you!
