METAMORPHOSIS MENTORSHIP PROGRAM APPLICATION Student's Name * First Name Last Name Address * City * Zip * Student Email * Age * Date of Birth * Cell Phone (###) ### #### Home Phone (###) ### #### Parent/Guardian Name * Parent/Guardian Phone * Parent/Guardian Email * Why do you want to be in the program? * How did you find out about our program? If referred by someone please provide their name,. * Education Information Name of School * School District * Grade * Tee Shirt Size * Please tell us what size you wear. Enter either S, M, L, XL, etc. School Activities/Clubs (e.g. Basketball, Cheer, Chess, Student Council, etc.) * Enter NONE if applicable 2023-2024 Personal Goals (Please list at least 1) * Social Media Status Instagram Facebook TikTok Student Signature * Parent/Guardian Signature * Electronic Signature Agreement. By selecting the "We Agree" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. * We Agree Your Application was submitted successfully!
