Heart Gallery Mentor Program Youth Application
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Print and send this completed form to: Lisa Long 880 Beltline Road Springfield, OR 97477 lisa@afamilyforeverychild.org office 541-343-2856 |
| _____ Yes, I want a mentor through the Heart Gallery Mentor Program. Initial here _______ **Please answer a few brief questions, sign and date.** Name _______________________________ What would you like to gain from this program? What are your strengths? What are your favorite activities to do? What are your hobbies? What is your favorite color? What is your favorite treat? What is your favorite subject in school? What is your favorite book, movie, cartoon, or show and why? What are some activities that you would like to do with your mentor? What qualities would you like your mentor to have? (examples: athletic, caring, friendly, funny, serious, a buddy) Signature _______________________________ Date _____________________ |