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Mentee Application
Your name
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Last name
Email address
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Address
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Street address
Apt/unit/box (optional)
City
State
Postal code
Phone number
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Phone type
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Birthdate
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Date
Gender
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Marital status
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Single
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Spouse's Name (if applicable)
What kind of mentoring are you interested in?
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Individual Mentoring
Marriage/Pre-Marriage Mentoring
Do you attend E91? If so, for how long?
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Other church activities involved in:
Tell us about you
Interests, hobbies, talents, desires, needs, hopes and passions!
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Please check any of the following that apply to you.
Depressed
Feel panicky
Suicidal thoughts
Inferiority feeling
Anxiety
Can't make a decision
None
What would you hope to gain from someone mentoring you?
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Is there a specific area or areas of your life that you would want to emphasize (career, spiritual, stage of life challenges, relationships, etc)?
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Do you know anyone currently from E91 that you think could be a good mentor for you? If so, please provide their name.
Do you have an age range that you would prefer in a mentor?
Emergency Contact Name
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Emergency Contact Email
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Emergency Contact Phone Number
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