Mentee Application


Welcome to Scholar Career Coaching Mentoring Program. We happy and looking forward to having you as a Mentee. Please complete and submit the application.

Mentoring Schedule:

  • Atlantic High (every other Wednesdays at 3:00 pm-5:00 pm)
  • Boynton High (every other Wednesdays at 3:00 pm-5:00 pm)

Click HERE to complete our student college and career planning pre-survey in addition to this application. Thank you!

* Required field
Basic Information
* First Name
* Last Name
Date of Birth
Contact Information
Mobile Phone
T-Shirt Size
Student ID Number
Demographic Information
* Gender
* Other Ethnicity
Primary Language
Other Primary Language
Address Information
Address 1
Zip Code
After School Availability
Other Information
Participates in free/reduced lunch
Household Size
Family Structure
* Other Family Structure
Career Focused Interests
Career Focused Interests Other
Interests Other
Referral Information
Referral Source
* Other Referral Source
Reason for Referral
Emergency Contact Information
Primary Emergency Contact
PEC Name
PEC Relationship
PEC Mobile Phone
Program Questions
* Select your age group:
* What is your country of origin?
* What School do you attend?
* What grade are you in?
* What is your GPA?
* Are you enrolled in ESOL?
* Is English your first Language?
If no, what is your first language?
* What is the highest level of your parents education?
* What is your favorite subject?
* What are (2) things you enjoy doing when you have free time (Hobbies)?
* Why did you sign up for mentoring? What are you hoping to gain from having a mentor?
* Have you previously participated in Scholar CC Mentoring Club before?
If so, at what school?
* Is there a specific person (Mentor) you would like to be matched with?
If so, who?
* What goal (s) do you hope your mentor could help you achieve?
* List TOP 3 Objectives: (What do you need help with the most?)
Please let us know about any challenges or problems at school (Any comments)?