YES - Mentee Application

Please fill out the form in its ENTIRETY. We need all the following information to begin the sign up process for the youth to receive a mentor. Thank You.


Please fill out ALL of the following information in regards to the youth you are referring:



Gender:

Race and Ethnicity:

Birthday:
Speak Spanish:



Please let us know a little bit about the youth, their interests, and personality to help us match them:

Interests and Hobbies:
Please fill in information regarding their school:

School Name:
Grade:
School District:
AISD:

Please provide the placement's information, if placed at an RTC, TLP, SIL etc. please put that information:

Living Arrangement:

Placement Name:
Placement Phone:
Placement Email:




Please provide the caseworker's information, we will contact them to let them know about the referral:

Case Worker Name:
Caseworker Phone Number:
Case Worker Email:
If it applies, please provide the Attorney Ad Litem’s information:

AAL Name:
AAL Phone:
AAL Email:
If it applies, please provide the CASA volunteer’s information

CASA Name:
CASA Phone:
CASA Email:
If it applies, please provide the case manager’s information

Case Manager Name:
Case Manager Phone:
Case Manager Email:
Please fill out the following information in regards to yourself:

Referrer's Name:
Referrer's Phone:
Referrer's Email:
Referrer's Agency:

Thank you so much for making a referral to the YES mentoring program we will be in touch with you and the youth as soon as we can.

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