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: First Name Last Name Gender: --None--Female Male Other Race and Ethnicity: --None--White Black Hispanic_or_Latino/a Asian Native American Hawaiian Native or Other Pacific Islander Bi-Racial Other Birthday: Speak Spanish: Phone Email 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: --None--8th Freshman Sophomore Junior Senior Graduated GED Not currently enrolled College Student School District: AISD: Please provide the placement's information, if placed at an RTC, TLP, SIL etc. please put that information: Living Arrangement: --None--Foster Home Independent living Placement Other Placement Name: Placement Phone: Placement Email: Street City State/Province Zip 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.