Mentee Application

If you’re interested in your young lady joining the Women In The Making program, please complete the online application below. Someone will contact you within a few days following reviewing your application.

Mentee Application

Mentee Information

New or Returning Youth?

New
Returning Youth

Name *

First

Last

Birthdate *

Grade Level *

School or Program *

Guidance Counselor / Favorite Teacher *

Interest/Hobbies *

Community Involvement (if applicable) *

Strengths *

Weaknesses/Current Struggles (whether school, socially, etc.) *

Career Aspirations *

Number of Members in Household *

Special concerns (allergies, behavior concerns, if any) *

Are there any special needs that we should be aware of to better accommodate your child?

Why are you or your child interested in the WIM program? *

Parent/Guardian

Name *

First

Last

Relationship *

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Parent's Email Address *

Please check if WIM has permission to photograph your young ladies during our activities

Participation in the program permits WIM to receive your daughter’s report cards, standard test scores, allows them to be photographed and recorded during workshop activities as well as travel on exposure outings.

The Cross and Anvil Human Services, Inc. offers programs and maintains inclusion policies that do not discriminate on the basis of race, color, religion, sex, age, marital status, national origin, disability, or sexual orientation. Our organization collects information concerning race, color, sex, and national origin to facilitate compliance with Titles VI and IX of the U.S. Civil Rights Act.

Supported by: Cross & Anvil Human Services Inc. 1201 7th Avenue South • St. Petersburg, Florida 33705 • Phone: (727) 821-0285 • www.womeninthemaking.org

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Background Check

Mentee Application