HSM Side-by-Side (Mentor Program) Form - Student

*First Name

*Last Name

*Email Address

*Phone Number

If you are interested in having a mentor, please complete this form so we can learn more about you and what you are looking for in a mentor. This will help us ensure that we match you with the most appropriate mentor. If you are a parent interested in your student being mentored, we do ask that your student fill out this request. We find the best mentoring relationships happen when students are open and willing to participate.

I am a:

Student interested in being paired with a mentor

*Student First Name:

*Student Last Name:

*Date of Birth:

*Gender:

MaleFemale

*School & Grade:

*Email:

*Cell Phone:

*Parent Name:

*Parent Email:

*Parent Phone:

*What is your involvement with Blackhawk Church and/or High School Ministries?:

________________________________________________________________

*What is your family background (do you have siblings, parents at home, etc.)?:

*What school or community activities do you participate in?:

*What are you considering/thinking about for post high school and career?:

*What are your interests and hobbies? :

*What are you passionate about in life right now?:

*How do you best connect with God?:

*How would friends/family describe you? (adventurous, intellectual, easy-going, outgoing, serious, quiet, lighthearted, etc.):

Any further comments about your spiritual journey you would like to share?:

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*Why are you interested in having a mentor?:

Have you ever been mentored before? Briefly describe your experience:

*What qualities are you looking for in a mentor?:

If you have a particular person(s) in mind, please include their name and how you know them:

*Can you commit to meeting once a month with your mentor? If not, why?:

Thank you for filling out this mentor request form! We look forward to pairing you with a mentor as soon as we can. You can expect an email from a staff member in the next couple of days to schedule a brief phone call. This phone call is an essential next step to the pairing process so that we can match mentees/mentors with complimentary personalities.

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