Mentorship & Organization Database Form

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Mentorship & Organization Database Form

Personal Information

Full name*

Phone*

Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Emergency Contact Information*

Background Information

Age and/or Education Level*

Current Employment Status*

Student

Employed

Seeking Employment

Self Employed

Business Owner

Career Interests or Fields of Interest*

Personal Goals*

Mentorship Preferences

Specific areas of interest for mentorship*

Preferred mentor background*

Current challenges or areas they want to improve through mentorship*

Availability for mentorship sessions (days/times)*

Organization Resource Needs

Types of support needed from partnering organizations*

Specific services they are interested in accessing post-program*

Participation in Previous Programs

Previous participation in Fort Worth Connect programs*

Progress or outcomes from prior programs (if applicable)*

Long-Term Goals

Long-term career, personal, or family goals*

How they hope mentorship or organization support will help them achieve these goals*

Commitment to Mentorship

Agreement to participate in regular mentorship sessions or check-ins*

Yes

No

Willingness to follow up with mentors or organizations to ensure progress is being made

Yes

No

Follow-Up and Feedback Preferences

Preferred method of communication for check-ins

Phone Call

Text

Email

Frequency of follow-ups*

Weekly

Bi-Weekly

Monthly

Feedback on how they would like to measure success or progress during the mentorship*

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