Mentee Sign Up

STUDENT/YOUTH APPLICATION

Thank you for your interest in Educate Tomorrow's Student/Youth Program!

When completing the Student/Youth Application through the Student/Youth Portal, please be sure to use Google Chrome

, Mozilla Firefox

or Microsoft Edge

. Using these three browsers will ensure a successful application submission as Microsoft no longer provides security updates or technical support for older versions on Internet Explorer. Without security updates, user systems become vulnerable to malware.

Student/Youth Demographics
First Name:	* Required
Last Name:	* Required
Street Address	* Required
Apartment/Unit # (if applicable)
City:	* Required
State:	* Required
Zip:	* Required
Student/Youth Contact Information
Home:	* Required
Cell:	* Required
Email:	* Required
*For signing into the Educate Tomorrow App*
Password:
Gender:	* Required
Date of Birth:	* Required
How did you hear about us?
Social Security (Last 4 digits)	* Required
Race:	* Required
Ethnicity:	* Required
Do you speak proficient English?	* Required
Language Spoken at home:	* Required

Student/Youth Household
# of Children under 18:	* Required
# of Siblings:	* Required
Parent(s) Living Arrangements:	* Required

Current G.P.A.
Elementary/Middle/High School
Date of High School Graduation
Diploma Earned

Date of College Graduation
Name of Institution where you earned your Associates
Bachelors Degree Earned
Bachelors Degree Earned

Date of Master's Degree Graduation
Name of Institution where you earned your Masters
Masters Degree Earned
Name of Institution where you earned your Doctorate
Doctoral Degree Earned

Have you ever been in trouble at school?
Are/ were you in special education?
Special Education Details

Is there already someone in your life that could be your mentor (family member, family friend, teacher, pastor, etc.).
If yes, person's name:
Person's phone:
Person's email:

Please answer the below questions if you are interested in having a Mentor.
What are your favorite subjects to read about?
What goals (educational and/or career) did you have for yourself when you were younger?
What is one goal you have set for the future?
If you could learn something new, what would it be?
What person do you most admire and why?
Describe your ideal Saturday

Please leave this checkbox blank

Student/Youth Demographics

Student/Youth Contact Information

Student/Youth Household