Personal Information
& Me Summer MENTEE Application
*For girls ages 14-17 years old | Program Duration: June 20 – September 22, 2025 | Mentoring Format: Virtual & Flexible Participation | Thank you for your interest in the & Me mentorship program! This program is designed to help you build confidence, resilience, and an unapologetic mindset. Please complete the form below so we can match you with the best mentor for your goals.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
-
Month
-
Day
Year
Date
Grade Level (as of next school year):
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Name
Next Semester START Date
Next Semester END Date (If You Know It)
Personal & Professional Goals
What are your TOP 3 personal or professional goals for the next few months?
What skills or qualities do you wish to develop through this mentorship
Confidence & Self-Worth
Resilience & Handling Setbacks
Public Speaking & Communication
Leadership & Decision-Making
Time Management & Productivity
Career Growth & Professional Skills
Business & Entrepreneurship
Other
What challenges are currently holding you back from achieving your goals
Skills, Talents & Interests
What are some of your strengths, talents, or skills?
What hobbies or passions do you have?
Are you currently working on any personal projects (blog, business, social media, creative work, etc)?
Yes (Please explain in the “other” space)
No, but I’d like to start!
Availability & Preferences
How much time can you commit to mentoring per week
1-2 hours per week
3-5 hours per week
Flexible, depending on schedule
How do you prefer to communicate with your mentor?
Phone/Video Calls
Text Message/Telegeam
Email
Other
Preferred mentoring format:
In-Person
Virtual
Both
Health & Safety Information
Do you have any medical conditions, allergies or special needs we should be aware of?
Yes (Please explain in the "other" space)
No
Other
Do you take any medications that might impact their participation in sessions?
Yes (Please explain in the "other" space)
No
Other
Mentee Expectations & Commitment
Why do you want to join this mentorship program?
How do you plan to take action on what you learn?
Are you committed to showing up, taking accountability, & following through on your goals?
Yes
I need help staying accountable
Are you available for the full program duration? (June 20-September 22) It’s okay if you can’t.
Yes
No (Please explain in the “other” space)
Other
Media Consent
Do you give permission for photos or video recordings of you to be taken during program events, sessions, or activities for use in the & Me's promotional materials (such as flyers, social media, website, or highlight videos)?
Yes, I give permission for my image to be used for promotional purposes.
No, I do not give permission for my image to be used
Final Confirmation
By submitting this form, you agree to actively participate, stay engaged, and respect the mentorship guidelines.
Next Steps
After submission, we will review your application and match you with a mentor. You will receive an onboarding guide and access to the mentorship community before the program starts.
Submit
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