General Information

Preferred Name / Nickname

Church or Faith Community (if applicable)

How did you hear about She L.E.A.D.S Mentorship?

Other referral source

Mentorship Interest

Why are you interested in having a mentor at this time?

What areas of life would you like mentorship in? (Check all that apply)

Other areas of life would you like mentorship in

Current Season of Life

How would you describe the current season of your life?

What are one or two goals you would like to work toward with a mentor?

Personal Reflection

What is one challenge you are currently facing?

What is one strength or gift you believe you have?

What do you hope mentorship will help you become or accomplish?

Mentorship Preferences

How often would you prefer to meet with a mentor?

Weekly

Twice a Month

Monthly

Flexible

Preferred Meeting Format

Do you prefer a mentor who has experience in a specific area?

Faith Background

How would you describe your faith journey?

Is spiritual guidance something you desire in mentorship?

For Youth Applicants (Under 18 Only)

Parent/Guardian Name

Parent/Guardian Phone Number

Parent/Guardian Email

School Name & Grade Level

I give permission for my child to participate in the She L.E.A.D.S Mentorship Program.

Parent/Guardian Signature

What days are you typically available?

Preferred Time

Commitment Agreement

Mentorship works best when there is honesty, consistency, and commitment.

By submitting this form, I agree to:

✔ Be open to growth and learning

✔ Respect the mentor’s time and guidance

✔ Maintain respectful communication

✔ Attend scheduled mentorship sessions when possible

Accept Concent *

Agree

Is there anything else you would like us to know about you?