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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. Obligatorio
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. Obligatorio

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.

Haz una donación

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.​

Frecuencia

Una vez

Semanalmente

Mensualmente

Anualmente

Monto

$25

$50

$100

$500

$1,000

Otro

0/100

Comentario (opcional)

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EIN: 33-3482295
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