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?*

Select

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?*