Professional Mentoring Youth and Young Adult Application

Please read carefully. Your application is a contract to participate in and strictly abide by the rules of the program. If you under 18, you will need consent of your parent or guardian to participate.

Name*
Age*
House Number*
Street Name*
City, State,Zip Code*
Phone*
Email Address*
Social Media Handle
Please provide Facebook, Instagram, Twitter, etc
Emergency Contact and Phone number*
LRBC Ministries*
Please identify which LRBC ministries you are part of
If none,what is your affiliation with LRBC and how did you hear about this program?
Education*
Current or most recent education, including grade/year and name of institution
Name of Employer*
Job Title*
Current or last position/title held
Employment End Date
Date Format: MM slash DD slash YYYY
Employment Start Date*
Date Format: MM slash DD slash YYYY
Hobbies, Clubs, Organizational Memberships
CAREER AND OCCUPATION INTERESTS
What 3 professions, careers, or occupations would you like to learn more about?*
Have you done any career explorations into the fields you indicated above? If yes, please explain.*
What kind of assistance would you like us to provide or what do you want to gain from this experience?*
Would you be interested in events that provide information and exposure to multiple career options? If yes, please indicate which days/times during the week work best for your schedule.*
Would you be interested in connecting with one or more of our Professional Advisors in a specific area of interest? If yes, which area or areas?*
Please check all areas that you might be interested in*
Other area. Explain :
Signature*
First Last
Enter Full Name
Final Step
Please Copy and paste the Link below into a separate browser/window and Paste results below: https://careerwise.minnstate.edu/careers/clusterSurvey?do=0*
https://careerwise.minnstate.edu/careers/clusterSurvey?do=0*
Disclaimer
This survey does not make any claims of statistical reliability and has not been normed. It is intended for use as a guidance tool to generate discussion regarding careers and is valid for that purpose. Note: Please ensure that you or your legal guardian (if you are under age 18) sign the CONSENT AND RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT FORM, which must be picked up from the church office (Lenox Road Baptist Church – 1356 Nostrand Ave., Brooklyn NY).

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Professional Mentoring Youth and Young Adult Application

CAREER AND OCCUPATION INTERESTS

Final Step

Disclaimer