High School Mentoring Program

Name *

Address *

City *

State

ZIP

Home Phone

Cell Phone

E-mail

What language do you speak at home?

Gender

Male

Female

Date of Birth

Month

Day

Year

Place of Birth

Enter the State/Country of birth.

Current School

Grade

Have you ever heard about the high school mentoring program at King's College?

yes

no

If yes, how did you learn about the program?

Do you want to go to college?

yes

no

If 'yes,' briefly explain why.

What is your favorite subject in school?

What is your least favorite subject in school?

Are you on a sports team at school?

yes

no

If 'yes', which team?

Are you in the English as a Second Language program (ESL)?

yes

no

Do you receive free or reduced price lunch at your school?

yes

no

Do you have an 8th period scheduled class?

yes

no

If 'yes,' which class?

The King’s College mentoring program meets on Mondays, from 3:15 to 4:30 at King’s College. Will you be finished with your classes and able to get to King’s by 3:15?

yes

no

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High School Mentoring Program