Name *

Are you applying to be a mentee or mentor? *—Please choose an option—MenteeMentor

Date of Birth *

Age *

Do you currently live, work, or attend school in Antelope Valley (Los Angeles County)? *
If no, please contact us for more info. We currently serve the Los Angeles County.—Please choose an option—YesNo

Mailing Address *

Email Address *

Phone *

How did you find about us? *

What is the highest level of education that you have completed *—Please choose an option—Some High SchoolHigh School Diploma/GEDSome College/No DegreeAssociate DegreeBachelor's DegreeMaster's DegreeProfessional DegreeDoctorateNoneOther

If you are a current student, then please list where you are currently enrolled, your major, and your expected completion date.

Are you currently employed? *—Please choose an option—YesNo

If yes, where? What do you do there?

How would you describe yourself? *

We want to know more about you and what you want to do in the future, but first... what's going on in your life at this time? *

Are you interested in help with... *—Please choose an option—Creating education goals/planCreating personal goals/planCreating career goals/planBalancing the demands of lifeExpanding knowledge of/involvement in the communityExploring new career optionsProgressing in your current fieldMeeting people in your fields of interestHaving guidance in decision-makingCoping with transitionHaving an accountability partnerOther

What do you hope to gain from your mentor? *

Anything else you'd like to share?