top of page

Mentee Registration Form

Thank you for your interest in our Mentorship program. Please complete the form below to register ages 12-18 for our specialized Mentorship program.

We're excited to have you join our community!

Parent/ Guardian Information

Mentee Information (Ages 12-18)

Race/Ethnicity (Check all that apply)
Does your child have an IEP or 504 Plan?

Interest & Goals

What specific areas would you like the Adult Mentor to support? Check all that apply. Required
Virtual Mentor sessions will take place in the late afternoon Monday - Thursday, with an in-person follow-up session Friday or Saturday. What are your preferred days for mentorship sessions? Check all that apply. Required

Consent & Agreements

Media Release: I GRANT permission for Memphis Youth Development Group to photograph, record, and use images or recordings of my child for promotional, educational, and reporting purposes.

Thank you submitting! A member of our team will reach out to you soon with next steps.

Make a donation

Thank you for your generous support! Your donation directly benefits local youth by funding youth programs, fingerprint-based background checks for mentors, safe city-wide events, and essential resources that promote their growth and development. Together, we can create a brighter future for our community's young people.​

Frequency

One time

Weekly

Monthly

Yearly

Amount

$25

$50

$100

$500

$1,000

Other

0/100

Comment (optional)

Quick Links

EIN: 33-3482295
bottom of page