Mentee Application

Address *

Phone number *

Birthdate *

Gender

Marital status *

Spouse's Name (if applicable)

What kind of mentoring are you interested in? *

Individual Mentoring

Marriage/Pre-Marriage Mentoring

Do you attend E91? If so, for how long? *

Other church activities involved in:

Tell us about you

Interests, hobbies, talents, desires, needs, hopes and passions! *

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? *

Is there a specific area or areas of your life that you would want to emphasize (career, spiritual, stage of life challenges, relationships, etc)? *

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 *

Emergency Contact Email *

Emergency Contact Phone Number *