Girls That Rock Mentor ApplicationReturning 2025-2026 School Year Name * First Name Last Name Nickname First Name Last Name Birthday MM DD YYYY Phone * (###) ### #### Email (non VBPS Email!) * Parent/Guardian Contact * First Name Last Name Phone * (###) ### #### Email 1 Are you employed? * Yes No Do you have transportation? * Yes No Will you be available? * Sessions will be held Every Wednesday of April 2:15pm-3:45pm Yes No I'm not sure yet Please list all extracurricular activities and times (tutoring, jobs, sports practices, etc.) * Favorite Subject * Math Social Studies Science ELA Least Favorite Math Science Social Studies ELA Hobbies * Why do you want to be a mentor? Describe some things that you would like to see in a mentoring program * Name a goal want to accomplish (it doesn’t have to be just in this program) * Thank you!
