Mentees form | Champions Circle

Mentee application form: (Champion Circle 2025)

To participate in the Champion Circle program, this form must be fully completed and signed, including the parent/guardian consent section. Incomplete applications will not be considered. All teens are encouraged to complete an application with the Give A Day Foundation to track their volunteer hours. Remember, teens are required to complete five hours of community volunteer work each month. The Give A Day Foundation offers volunteer opportunities and can assist them in reaching those hours!

Date

Mentee information

Name *

First

Last

Date of Birth *

Address *

Address Line 1

City

State

Zip Code

Phone number *

Email *

Preferred T-Shirt Size *

Which school do you currently attend? *

Academic Grade *

Current Grade Point Average (GPA) *

Parent/Guardian information

Parent or legal guardian *

Mother
Father
Mother & Father
Guardian

Mother name *

First

Last

Mother address *

Address Line 1

City

State

Zip Code

Mother mobile phone number *

Mother email *

Father name *

First

Last

Father address *

Address Line 1

City

State

Zip Code

Father mobile phone number *

Father email *

Guardian name *

First

Last

Guardian address *

Address Line 1

City

State

Zip Code

Guardian mobile phone number *

Email *

Emergency contact

Please provide the name and contact information of someone we can reach in case of an emergency.

Name

First

Last

Phone

Relationship to Applicant

Program commitment

Champion 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 month

Mentee areas of interest

Please select the areas that interest you or would like guidance in: *

Academic Support: Help with study skills, organization, and tutoring in challenging subjects
Emotional 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.
Other

If 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? *

If 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? *

If yes, please list the medication name(s) and purpose.

Disclaimer and Acoknowledgement:

I certify that my answers are true and complete to the best of my knowledge. If this application leads to enrollment, I understand that false or misleading information in my application or interview may result in the release of the youth named above. Participation in this program is a privilege and not a right. Both the parent/guardian and youth must understand this concept. If the rules and regulations are not followed the youth can be removed from the program at any time.

Mentee name *

First

Last

Mentee signature *

Parent/Guardian Consent:

I, the parent or legal guardian for 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, who shall be selected from the community and will be screened and trained, before participating in the program. I understand that I must participate in an orientation session in which the program will be explained. I understand that Champion Circle will provide ongoing monitoring of the mentoring activities. I give the Champion Circle program coordinator permission to obtain the youth named above, academic and attendance records from his school. I give permission for Champion Circle to utilize photographs of the youth named above, that will be taken during his involvement in the program and waive all rights of compensation. I understand that there is no fee involved, but the youth named above, must complete 5 community volunteer service hours every month.

Parent/Guardian name *

First

Last

Parent/Guardian signature *

Parent/Guardian agreement: *

I agree

I agree to support the Champion Circle program to the best of my ability if the youth named above is accepted.

Mentee application form: (Champion Circle 2025)

Mentee information

Parent/Guardian information

Emergency contact

Program commitment

Mentee areas of interest

Disclaimer and Acoknowledgement:

Parent/Guardian Consent:

Give A Day Foundation

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Give A Day Foundation

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