MY Project USA Mentee Intake Form

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Under MY Wing

Mentee Application Form

Under MY Wing initiative is a comprehensive mentorship program that is open to local high-school-aged teens of immigrant origin who come from low-income families or plan to be the 1st person in their family to attend college. This initiative will embed mentoring and career exploration into an existing community-based program, MY Project USA, that currently offers an array of effective social services for adults and youth. The design includes an intervention that will fill gaps in soft skills development and college readiness. Mentees who successfully complete the program may be eligible for a scholarship.

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Phone*

Home Email*

Gender*

Date of Birth*

Ethnicity*

Somali Bantu Somali Other African American - New American Afro-American (Black) Asian Hispanic White Other

If Other, Specify:

Please answer all of the following questions:

1. Are you applying to participate for a mentorship?*

Yes No Maybe

2. Name of the high school you attend*

3. What high school grade are you entering in the Fall?*

Freshman Sophmore Junior Senior

4. How can this opportunity help you to achieve your academic goals?*

5. Does your family receive SNAP benefits?*

Yes No

6. Will you be the first in your family to attend college?*

Yes No

7. Do you consider yourself of immigrant origin?*

Yes No

8. Do you understand that all pictures and materials gained from this initiative are the property of MY Project USA?*

Yes No

A copy of your responses will be emailed to the address you provided.

Submit

Name
Address Line 1, Address Line 2
City, State Zip Code
Cell Phone
Contact Email

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Name
Address Line 1, Address Line 2
City, State Zip Code
Cell Phone
Contact Email

Facebook

Twitter

Instagram