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 filling out this form on behalf of your student, please make sure your student is interested in meeting with a mentor before completing the form. 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 mentorParent interested in finding a mentor for my student

*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?:

_________________________________________________________________

*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?:

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