Interested in Becoming a Mentee?
Name of Participant
*
Participant Email:
*
Participant Phone Number
*
Parent’s Email Address
*
Parent’s Phone Number
*
Phone
Address
*
Which of our office locations is closest to you?
*
What grade are you in during the 2024/2025 school year?
*
What school are you attending during the 2024/2025 school year?
*
Please let us know if you were referred to this program by a friend, parent, guidance counsellor or Black Achievers Program participant or mentor. Write "NA" if you were not referred.
*
In 2-3 sentences, can you tell us a little bit about why you are interested in joining the program?
*
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