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Student Interest Form
Alexa Smith
2026-04-27T14:39:05-04:00
Student Interest Form
Name
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Name
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Last
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Grade
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About the Mentoring Program
Our mentoring program gives students the opportunity to meet with a caring adult mentor during the school year. Mentors are positive role models who can listen, encourage, help students set goals, and support them in school and life. Mentoring may include talking, reading, playing games, working on goals, learning new skills, or participating in other positive activities.
Are you Interested?
Please check one:
Yes, I am interested in having a mentor
Maybe. I would like to learn more first
No, I am not interested at this time
What would you like in a mentor?
Check any that apply:
Someone who listens
Someone who is encouraging
Someone who is patient
Someone who is fun
Someone who helps me with my goals
Someone who like activities or games
Someone who can help me feel more confident
Other
Other
What would you like to do with a mentor?
Talk
Read
Play Games
Work on school goals
Learn about careers
Do creative activities
Other
Other
Student Comments
Is there anything you would like us to know?
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