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We can only move forward with your application once we have contacted your parent or guardian, so please ensure you provide valid parent/guardian contact information.
Question 2 of 28
Parent/Guardian Full Name
Question 3 of 28
Parent/Guardian Email
Question 4 of 28
Parent/Guardian Phone
Question 5 of 28
Does your household have access to a reliable internet connection?
Yes
No
Information
Question 7 of 28
Full Name
Question 8 of 28
Gender
Male
Female
Question 9 of 28
Age
Question 10 of 28
Date of Birth
Question 11 of 28
Email
Question 12 of 28
Phone #
Question 13 of 28
Address
Question 14 of 28
City/State/ZIP
Question 15 of 28
Education Level and Current School
Question 16 of 28
Race/Ethnicity
Interests and Goals
Question 18 of 28
What are your interests and hobbies?
Question 19 of 28
Why are you interested in joining the WTFMA mentoring program?
Question 20 of 28
What are your personal or professional goals?
Availability
Question 22 of 28
Are you available to attend the weekly group call at 5p CST ?
Question 23 of 28
Are you available for meetings and activities at our resource center at 1800 N 25th St, East St Louis, IL 62204 ?
Question 24 of 28
Preferred Days/Times for Participation
Additional Info
Question 26 of 28
What do you hope to gain from this mentoring experience?
Question 27 of 28
Any specific skills or areas you'd like to develop?
Question 28 of 28
I confirm that the information provided in this application is true and accurate to the best of my knowledge. I understand that any false information could affect my eligibility