Group Name: Organization Name: Type of Organization: Faith Based Business No Preference School Based Location: Goals: Liaison/Group Leader: Liaison/Leader Email: Liaison/Leader Phone: Type of Program: Group Mentoring 1-to-1 Mentoring Peer-to-Peer Mentoring Target Grade Levels: 2nd-6th 7th-8th 9th-12th No preference Meeting Location: Worksite School Community-Based Have you already been connected with students and would like our program support? Yes No Potential Training Dates: Preference Amount of Mentoring Time: Preferred Group/1-to-1 Mentoring Meeting Days: Anticipated Start Date: Submit Request
