Mentee Interest Form

Student name *

First

Last

Student Date of Birth *

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone

How did you hear about this mentoring program? *

What languages do you speak and what is your fluency in them? *

Check all subjects that you would like help with *

• Math
• English
• Science
• History
• Music
• Musical Instrument
• Social Studies
• Foreign Language
• Homework
• Test Preparation

Check all subjects that you feel are your strength

• Math
• English
• Science
• History
• Music
• Musical Instrument
• Social Studies
• Foreign Language
• Homework
• Test Preparation

Would you prefer online meetings on in-person or a mix of both? *

• online
• in-person (at school or a library)
• a mix of both online and in-person

Please share anything else that you would like your mentor to know

Please share anything else that you would like Higher Orbit to know

Submit