Mentee Application

Name*
First Last
Contact
Phone Number
Address*
Street Address Address Line 2 City State ZIP Code
Birth Date*
Are you the________:*
Who do you live with?*
- Mother
- Father
- Both Parents
- Grantparent(s) / Other Guardian
- No one, by myself
Do you have any siblings?*
- Brother(s)
- Sister(s)
- No
How many?*
Please enter a number greater than or equal to 1.
How many?*
Please enter a number greater than or equal to 1.
Do you speak any foreign languages? If so, please list them.
Are you a Christian?*
Are you Baptized?*
Are you a member of the Lenox Road Baptist Church?*
Approximate Date of Baptism*
MM slash DD slash YYYY

If you don't remember the exact date of Baptism, Please choose the closest date.
Which Ministries are you involved in?*
Which services, meetings, or events do you attend*

What are your special interest or skills?*
What do you like to do in your spare time?*
Examples might be: watch TV, Video Games, shopping, reading, movies, cultural events, playing sports etc
What do you want to do when you get older?*
Are you currently employed*
Are you employed:*
- Full Time
- Part Time
Where are you employed?*
What do you do at work?*
Please select any of the following careers that interest you*
Please select all the words that describe you*

What do you expect from LRBC Mentor*
Is there anything else that you would want your LRBC Mentor to know about you?*
Have you ever had a mentor before?*
- Yes
- No
How long ago did you have a mentor?*
How would you describe your experience with your mentor?*
Current or former Mentors Name*
What are the best times for your Lenox Mentor to connect with you?*
i.e. weekends, afternoons, after school, mornings etc.
How do you feel about volunteering with your Lenox Mentor in at least one LRBC event?*

Mentee Education