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Mentor Participant Profile by nOcNk9fM

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									                                     PARTICIPANT PROFILE
                                       INTERVIEW FORM


Student Name: _____________________________________________________________
                            First             Middle Initial              Last


Mailing Address:____________________________________________________________
                            Street                             City              Zip


Home phone: (           ) _______--_________ Cell phone: (     ) _______--__________

________________________________________@______________________________
Student Email Address


Gender: Female or Male Date of Birth: ____/____/_______
                                            MM/DD/YYYY


Ethnicity:______________________________________

Parent/Guardian #1: _________________________________________________________
                            First             Middle Initial              Last


Work phone: ( ) _______--_________ Cell phone: ( ) _______--__________

________________________________________@______________________________
Parent/Guardian #1 email address


Parent/Guardian #1: _________________________________________________________
                            First             Middle Initial              Last


Work phone: ( ) _______--_________ Cell phone: ( ) _______--__________

________________________________________@______________________________
Parent/Guardian #1 email address




Hobbies/Interests

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________
Career Interests

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________


What are your favorite classes in school?
________________________________________________________________________

What subjects do you need help in? ___________________________________________

What is your current grade point average? _____________________________________

What characteristics would you like to have in your mentor?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________


What other obligations do you have? (work, clubs, family, church, etc.)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

When can you meet with your mentor on the school campus? ________________________


What are your current college choices?


1._______________________ 2. _______________________3. _______________________

								
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