Mentee Application

Mentee Form

Child's Information

Which BCYMP Mentoring Program(s) are you interested in for your child? You may select more than one. *
Child's Gender *

Parenting Adult’s Name and Contact Information

May BCYMP text you? *
Address *
Address
City
State/Province
Zip/Postal
Does the child have another household besides this one? *

Secondary Household Name and Contact Information

Address
Address
City
State/Province
Zip/Postal

More About Your Child

Pleae check all the following interests your child has. *

Household Information

The parenting adult(s) in this child’s household is (check all that apply)

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