2025-26 Mentee Application

(To Be Completed by the Parent/Guardian)

Tell Us About Yourself

Medical History

Parental/Guardian Consent.

(Please read this carefully before signing)

Bridge Builders Academy appreciates you and your son’s interest in his becoming a mentee. This application is intended as a means of informing and gaining the consent of the parent/guardian to allow their son to participate in the Bridge Builders Mentoring Program.

After receiving this completed application from you, we will evaluate the information and notify you if your child has been accepted into the mentoring program. Much of the information you supply in this application packet will be used to match your son with an appropriate mentor. Therefore, the mentoring team may, at times, need to access and share this information with prospective mentors and other parties when it is in the best interest of the match. However, we do not reveal names until there is an initial interest from the mentee, parent/guardian, and mentor based first upon anonymous information provided about each other.

Contact and Information Release

(To Be Completed by the Parent/Guardian)

I hereby grant permission for Bridge Builders Academy to make contact with my child and conduct a personal interview for the purposes of applying to be a mentee. Bridge Builders Academy may also make contact with my child on school premises for the purposes of screening and interviewing as well as ongoing support of his participation in the mentoring program.

I authorize Bridge Builders Academy to obtain any needed information regarding my child from teachers, counselors, and other administrative staff.

Further, I understand that basic information about my child will be anonymously (without names) shared with a prospective mentor(s) to aid in determining a suitable match. Once a mentor/mentee match is determined, my and my child's identity and other relevant information will be shared with the mentor to the extent it aids in facilitating a successful match.

Mentee Contract and Code of Conduct

By choosing to participate in the Bridge Builders Academy Mentoring Program, I agree to:

I agree to follow all the above stipulations of this program as well as any other conditions as instructed by the program coordinator at this time or in the future.

Parent/Guardian Contract

By allowing my son to participate in the Bridge Builders Mentoring Program, I agree to:

• Allow my child to participate in the Bridge Builders Academy Mentoring Program and to be matched with a mentor

• Follow and encourage my child to follow all rules and guidelines as outlined by the program coordinator, mentee training, program policies, and this contract

• Support my child in this match by allowing him to meet with his mentor at from two to eight hours per month and have weekly contact with him for one year

• Support my child being on time for scheduled meetings or have him call the mentor at least 24 hours beforehand if unable to make a meeting

• Regularly and openly communicate with the program coordinator as requested

• Inform the program coordinator if I observe any difficulties or have areas of concern that may arise in the match relationship

• Participate in a graduation/closure process when that time comes

• Notify the program coordinator if I have any changes in address or phone number

• Provide the program coordinator and the mentor with any updated health insurance information for my child

I agree to follow all the above stipulations of this program as well as any other conditions as instructed by the program coordinator at this time or in the future.