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WORTHY IN GOD

STUDENT MENTOR INTAKE FORM AGES (10-17)


“FOR I KNOW THE PLANS I HAVE FOR YOU,” DECLARES THE LORD, “ PLANS TO PROSPER YOU AND NOT TO HARM YOU, PLANS TO GIVE YOU HOPE AND A FUTURE.”


PURPOSE

THIS FORM HELPS US UNDERSTAND EACH STUDENT’S NEEDS, INTERESTS, AND GOALS SO WE CAN PROVIDE FAITH BASED MENTORSHIP IN A SAFE, RESPECTFUL, AND GOD HONORNING ENVIROMENT.



STUDENT INFORMATION

Birthday
Month
Day
Year
GENDER

PARENT / GUARDIAN NAME

FAITH & PERSONAL GROWTH

DO YOU ATTEND CHURCH?
What area would you like mentorship in?
Faith & spiritual growth
Confidence & self worth
School & academics
Emotional support
Leadership
Life skills

About You


FAITH & VALUES


Are you open to faith-led mentorship, guidance, and prayer?

GOALS

CONSENT

Are you willing to participate fully and communicate consistently?
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