YES - Mentee Application

Please fill out ALL of the following information. All information is kept in a secure database and is used in the matching process.

We need ALL the following information to begin the sign up process for the youth to receive a mentor. Thank You

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This section is for information on the YOUTH, fill out all that you know:

Please note: all fields with an are required.





Gender:

Race and Ethnicity:

Birthday:
Speak Spanish:




School Name:
Grade:

School District:
AISD:

In DETAIL please provide youth's interests, hobbies and personality. The more information you give the better match we can make!

Interests and Hobbies:

Please provide placement's information (person youth lives with).

TCJPD PO's please fill the placement's information where the youth will return to live:


Placement Type:

Placement Name:
Placement Phone:
Placement Email:




If applicable provide the CPS 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 applicable, 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:

If you are not brought to a thank you page, the form did NOT submit. Please check that ALL required fields are filled out.


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