Group Mentoring Discovery Form - Cincinnati Youth Collaborative

Group Name:

Organization Name:

Type of Organization:

School Based Location:

Goals:

Liaison/Group Leader:

Liaison/Leader Email:

Liaison/Leader Phone:

Type of Program:

Target Grade Levels:

Meeting Location:

Have you already been connected with students and would like our program support?

Potential Training Dates:

Preference Amount of Mentoring Time:

Preferred Group/1-to-1 Mentoring Meeting Days:

Anticipated Start Date:

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301 Oak Street | Cincinnati, OH | 45219 | 513-363-5200