Teach Me 2 Tie Inc. Mentor Connect Application Form

Thank you for your interest in the "Mentor Connect" program. This form is designed to help us understand your young man’s needs and match them with a suitable mentor. Please fill out the following details completely.

1. Parent/Guardian Information

Full Name *

Relationship to Applicant *

Parent

Guardian

Other

Others:

Phone Number *

Email Address *

Address (Street, City, State, Zip Code) *

2. Young Man’s Information

Full Name *

Date of birth *

Age *

Grade Level *

School Name *

3. Interests and Personality

Please describe your young man’s personality: *

What are their hobbies, interests, or talents? *

What areas do they need guidance or mentorship in? (Check all that apply) *

Academic Support

Career Exploration

Life Skills (e.g., tie-tying, grooming, etiquette)

Emotional Support

Social Skills

Type Others Here

4. Mentorship Goals

What are your primary goals for this mentorship program? *

Are there any specific challenges or concerns you’d like the mentor to address? *

5. Scheduling and Availability

Preferred Days for Mentorship Sessions: (Check all that apply) *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Preferred Times: *

Morning

Afternoon

Evening

Are there any specific schedule restrictions we should consider?

6. Additional Information

Are there any medical conditions, allergies, or special needs we should be aware of?

Any additional notes or comments?

7. Consent and Agreement

By signing below, I acknowledge that this is an application for the Mentor Connect program and does not guarantee immediate placement. I understand that all information provided will be kept confidential and used solely for program purposes.

Parent/Guardian Signature: *

Clear

Date: *

I agree to TEACH ME 2 TIE INC.'s privacy policy | terms and conditions. By providing my phone number I agree to receive text messages from TEACH ME 2 TIE INC. Message and data rates may apply. Message frequency varies. Text HELP at (910) 996-4235. Text STOP to cancel.