Please enable JavaScript in your browser to complete this form. - Step 1 of 4Mentee application form: (2025 Champion Circle)To participate in the Champion Circle program, the application form must be fully completed and signed, including the parent/guardian consent section. Incomplete applications will not be considered. We encourage all teens to complete an application with the Give A Day Foundation to track their volunteer hours. Please note, teens are required to complete five hours of community volunteer work each month. The Give A Day Foundation provides volunteer opportunities and can help them meet their hour requirements!Date Mentee informationName *FirstLastAddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone number *Email *Date of Birth *Preferred T-Shirt Size *Choose oneChoose oneYouth largeSmallMediumLargeX Large2X Large3X LargeWhich school do you currently attend? *Academic Grade *Choose oneChoose oneMiddle school eighth gradeFreshmanSophomoreJuniorSeniorCollegeCurrent Grade Point Average (GPA) *NextParent/Guardian informationParent or legal guardian *MotherFatherMother & FatherGuardianMother's name *FirstLastMother's address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMother's phone number *Mother's email *Father's name *FirstLastFather's address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFather's phone number *Father's email *Guardian's name *FirstLastGuardian's address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeGuardian's phone number *Guardian's email *Emergency contactPlease provide the name and contact information of someone we can reach in case of an emergency.Name *FirstLastPhone *Relationship to Applicant *NextProgram commitmentChampion Circle is designed to develop leadership, personal growth, and community engagement. As part of this program, mentees are required to: ✅ Attend scheduled meetings and events ✅ Participate in workshops and activities ✅ Complete at least 5 hours of community service per monthMentee areas of interestPlease select the areas in which you are interested or would like guidance: *Academic Support: Help with study skills, organization, and tutoring in challenging subjectsEmotional Well-being: Guidance on managing stress, emotions, and building resilience.Social Skills: Developing healthy friendships, resolving conflicts peacefully, and understanding boundaries.Health and Fitness: Encouragement to stay active, eat well, and understand the importance of physical health.Career Exploration: Introducing different career paths, offering resume building workshops, and mock interviews.Financial Literacy: Teaching about budgeting, saving, and understanding the basics of personal finance.Life Skills: Learning practical skills like cooking, household management, and time management.Community Involvement: Encouraging volunteerism, civic engagement, and understanding the impact of giving back.Personal Development: Setting goals, building self-confidence, and exploring interests and passions.Safe and Ethical Internet Use: Educating on internet safety, responsible social media use, and digital footprint awareness.OtherIf other please explain:Briefly tell us how you hope this program will benefit you and what are your expectations for this program: *Does your teen have any allergies? *YesNoIf yes, please list all types of allergens, including food, environmental, and medication allergies.If yes, list them below.Does your teen take any prescription medication?YesNoIf yes, please list the medication name(s) and purpose.NextDisclaimer and Acknowledgment: Please read and acknowledge the following information before proceeding:I certify that the information provided in this application is true and complete to the best of my knowledge. If this application leads to enrollment, I understand that providing false or misleading information during the application or interview process may result in the removal of the youth named above from the program. Participation in this program is a privilege, not a right, and both the parent/guardian and the youth must understand this. Failure to follow the rules and regulations may result in the youth’s removal from the program at any time.Mentee name *FirstLastMentee signatureClear SignatureParent/Guardian Consent: I, the parent or legal guardian of the youth named above, hereby give my permission for him to participate in the Champion Circle program. I fully understand that the program involves mentors selected from the community, all of whom will be screened and trained prior to their involvement. I acknowledge that I must participate in an orientation session where the program will be explained. I understand that Champion Circle will provide ongoing monitoring of the mentoring activities. I also give the program coordinator permission to obtain the academic and attendance records of the youth named above from his school. I grant permission for Champion Circle to use photographs of the youth taken during his participation in the program, and I waive any rights to compensation for their use. I understand that there is no fee for participation in the program; however, the youth named above is required to complete 5 community volunteer service hours every month.Parent/Guardian name *FirstLastParent/Guardian signature *Clear SignatureParent/Guardian agreement: *I agreeSubmit