Women to Woman Mentee Sign-Up Form

Background Information

1. What is your current situation?

2. Do you currently have a support system in place?

3. What challenges are you currently facing? (Check all that apply)

Education (e.g., schoolwork, GED preparation)

Employment (e.g., finding a job, career guidance)

Life Skills (e.g., budgeting, cooking, time management)

Emotional Support (e.g., coping with stress, self-confidence)

Social Skills (e.g., building relationships, communication)

4. Are you currently studying? If yes, what year level?

5. What part of the event are you looking forward to the most?

2. What areas would you like your mentor to help you with? (Check all that apply)

Career Readiness and Job Skills

Life Skills (e.g., budgeting, cooking, time management)

Educational Support (e.g., tutoring, GED preparation)

Emotional Support and Self-Confidence Building

Social Skills and Community Engagement

Goals and Interests

1. What are your main goals for joining this program? (Check all that apply)

How many hours per week can you commit to meeting with your mentor?

1-3 hours

4-6 hours

7-10 hours

3. Do you have any specific skills or interests that you would like to explore further?

4. Is there anything else you would like us to know about your goals or interests?

Availability

Do you have any preferences for your mentor? (e.g., gender, background, area of expertise)

Additional Information

Have you participated in any mentorship programs before?

Yes

No

Please provide an additional emergency contact

Do we have your permission to add you to our email list?

Is there anything else you would like to share with us?

Signature

By submitting this form, I confirm that the information provided is accurate to the best of my knowledge. I understand the importance of open communication and participation in this program and commit to actively working with my assigned mentor in alignment with the Women to Woman program’s mission and guidelines.

DISCLAIMER:

As a non-profit initiative, we endeavor to provide valuable services to the community. However, we make no representations or warranties of any kind, express or implied, regarding the reliability, accuracy, or completeness of the program content. By participating, you agree to hold the organization harmless for any discrepancies or misinterpretations.