Enroll today!

We are currently accepting applications for the enrollment period starting on August 17, 2015. If you are interested in enrolling, please fill out the application below. Feel free to contact us for any questions about our programs.

Mentee's Name (required)

Email (required)

Street Address

City/State/Zip

Home Phone

Cell Phone

Date of Birth

Ethnicity

Name of School

Grade

Parent/Guardian Name

Relationship to Mentee

Parent/Guardian Phone

Parent/Guardian Email

Emergency Contact (name, relationship, phone

MEDICAL HISTORY

Does the mentee have any physical problems or physical limitation? If so, please explain:

Is the mentee currently receiving any medical treatment for any medical conditions? If so, please explain:

Does the mentee have any allergies or adverse reactions to medications, food, products?

Are there any other known medical conditions that would prevent the mentee from participating in certain activities? If so, please explain:

GENERAL MENTORING QUESTIONS

Why do you feel the mentee should be a part of F.L.A.W.? What would you like for her to gain from the experience?

What are three goals that you would like for the mentee to achieve during the experience?

Is the mentee available to meet once a month for group mentoring? Yes or No

Is the mentee able to meet once a week for an hour? Yes or No

Is the mentee willing to attend the initial mentee training session and monthly on-going training? Yes or No

Will the parent and/or guardian be willing to attend the initial parent/guardian meeting? Yes or No

Is the mentee currently having any behavioral or social problems at home, school, or within their community? If so, please explain.

Do you have a mode of transportation? Yes or No