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First name*

Last name*

Date of birth*

I am interested in applying for:

the spring/summer 2024 peer mentoring cohort

the 2024-25 school year peer mentoring cohort

I'm unsure or need more information

Gender Identity

Pronouns

Not sure what this means? See this pronoun guide from GLSEN.

School*

Grade/Year in School*

Phone number*

Email*

Best way to reach you*

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone Number

UpStreet will check personal references on every applicant. Please list three people who know you well and can attest to your character, skill, and dependability.

Reference 1 Name *

Reference 1 Phone Number*

Reference 1 Email*

Reference 2 Name*

Reference 2 Phone Number*

Reference 2 Email *

Referenence 3 Name*

Reference 3 Phone Number*

Reference 3 Email*

We want to know a little more about you.

Please choose up to THREE words that describe you well.

Outgoing

Quiet

Funny

Dramatic

Serious

Emotional

Friendly

Calm

Confident

Hopeful

Curious

Cautious

Brave

Helpful

Creative

Hardworking

Kind

Knowledgeable

Happy

Why do you want to be a menor with UpStreet? *

Do you have a mentor? *

It does not need to be a mentor through a formal program, but anyone you look up to, seek advice from, rely on for support, can call when you're having a bad day.

Yes

If you answered yes to the previous question, what significance has that relationship had to you?

What other activities, if any, are you involved in? *

Is there anything else you'd like us to know about you? Is there any information that would be helpful for matching you with a mentee?