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Is It For Me?
The Positive Mentor
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+Mentor Enrollment Form
First name
*
Last name
*
Preferred pronouns
Email
*
Phone
*
Birthday
*
Day
Month
Month
Year
Current Year Level
*
Parent/Guardian name
*
Parent/Guardian phone
*
Parent/Guardian email
*
Which program are you interested in?
*
What are your expectations/goals that you hope to acheive in this program?
*
Growth
Self-discovery
Empowerment
Confidence
Resilience
Self-improvement
Clarity
Direction
Focus
Motivation
Other
What are your specific areas of interest or strengths you would like to focus on?
Leadership
Creativity
Communication
Time Management
Organisation
Problem-solving
Emotional Intelligence
Collaboration
Adaptability
Innovation
Critical Thinking
Motivation
Decision-making
Goal Setting
Stress Management
Well-being management
Other
Have you participated in any mentorship or personal development programs before? If so, please provide details.
Do you have any specific challenges or areas where you would like additional support?
Are you able to commit to attending regular sessions and engaging in program activities?
Yes
No
Do you have a preferred schedule or time of day for sessions?
Yes
No
What days and times would you prefer your sessions to be scheduled?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
AM
PM
Do you have access to a stable internet connection and a device for virtual sessions?
Yes
No
Do you grant permission for The Positive Mentor Programs to share your contact information with your assigned mentor?
Yes
No
Is there any additional information or special accommodations that you would like us to be aware of?
Submit
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