Youth Mentee Application form | The Grandparents Community Network

Student Information

Student Name

Date Of Birth

Age

Grade

School Name

Caregiver Information

Caregiver Full Name

Relationship to child

Caregiver Phone

Caregiver Email

Multi-line address

Country/Region

Address

City

Zip / Postal code

Eligibility Requirements

Why would this child benefit from a mentor?

Please share details about the support and guidance your child needs

Areas where Support is needed

(Select all that apply)

Student Interests

Hobbies

Favorite Subjects

Activities They Enjoy

Mentor Matching Preferences

Documents & Photo Uploads

Upload Student ID (Report Card, School ID, etc.)

PDF, JPG, PNG (Max. 10 MB)

Upload Guardianship Documents (if available)

PDF, JPG, PNG (Max. 10 MB)

Photo of Child (for records only)

PDF, JPG, PNG (Max. 10 MB)

Caregiver Consent

I confirm the child is 17 or younger

I confirm the child is being raised by a relative caregiver

I confirm that the child is currently enrolled in school.

I give permission for my child to be considered for mentoring services.

I understand the information provided is true and accurate.

Caregiver Signature

Caregiver/ Relative Name

Signature

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