Mentee Profile Sheet

Name: ___________________________________

Address: _________________________________

City: __________________________________ State: ________ Zip: _____________

Phone: ______-___________ E-mail Address: ______________________________________

Male/Female: _______________ Ethnicity: ______________________ Grade: ____________

School: ____________________________________ School Phone: _______- ____________

Parents/Guardians: ___________________________________ Phone: _______-___________

Emergency Contact: __________________________________

 

Relationship to mentee: _______________________________

Phone: _____- ________ Work Phone: ______-__________

 

Hobbies/Interests: ________________________________________________________________

________________________________________________________________

________________________________________________________________

Career Interests: _________________________________________________________________

_________________________________________________________________

Academic Profile

School: ______________________________

Subjects needed help in (circle all that apply):

Reading Science Math Social Studies
P.E. E.S.L. Composition Foreign Language

Other: _______________________________

Grade Point Average: ___________________ Recent Test Scores: _____________________

Other Academic issues (attendance, discipline problems, etc.) ___________________________________________________________________________

___________________________________________________________________________

Match Criteria

Times available for meeting with a mentor:

  Lunch: __________ Extended Day/Afterschool Program: _______ Other: _________

Desired mentor characteristics: __________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Other obligations (employment, family, religious, etc.): _______________________________

___________________________________________________________________________

___________________________________________________________________________