Enroll in the Mentoring Hour The Mentoring HourMondays, 3:30pm - 4:30pm STUDENT INFORMATION: Student Name * First Name Last Name Student Email * Student Phone (###) ### #### School Grade Student Date of Birth MM DD YYYY Gender Male Female Other Race and Ethnicity Asian Black/African American Hispanic/Latino Middle Eastern Native American/American Indian White/Caucasian Other PARENT / LEGAL GUARDIAN INFO: Parent Name * First Name Last Name Parent Email * Parent Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Relationship to Student STUDENT'S INTERESTS Career Interests College(s) of Interest What areas would you like to work on with a career mentor? How did you hear about the Youth Career Institute? More About You Student Acknowledgement I will review the Code of Conduct for Students with a parent/guardian and obtain their signature to complete my registration. Thank you enrolling in The Mentoring Hour with Youth Career Institute! We will get in contact with you soon to complete your registration. THE MENTORING HOUR:REGISTRATION FORM VIEW SCHEDULE BE A MENTOR
