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Interested in becoming one of our mentors?

MENTOR

Interested but need more information.

PARENTAL REGISTRATION FORM

Empowering Youth Through Mentorship and Life Skills Education

Child's Full Name

Parent or Guardian's Full Name

Child's Date of Birth

Month

Day

Year

Phone

Physical Address

Mailing Address (if different from above)

Preferred Method of Contact

Current Grade Level

Child's Race / Ethnicity

Child's Gender

Name of School Attending

Parent/Guardian Goals and Expectations

1. What are your primary goals for your child’s development through the WESOURCE program?

2. What specific skills or areas would you like to see your child improve in?

3. What are your expectations of the program in supporting your child’s overall growth and well-being?

4. Are there any particular challenges your child is currently facing that you hope this program can help address (e.g., social skills, academic performance, self-confidence)?

Understanding Your Child

Likes and Dislikes

1. What are your child’s favorite activities, hobbies, or interests?

2. Are there any activities your child strongly dislikes or prefers to avoid?

Academic Preferences

1. What is your child’s favorite subject in school and why?

2. What subject does your child find most challenging or least enjoyable, and why?

3. Does your child have any learning difficulties or special needs we should be aware of?

Personal Preferences

1. What is your child’s favorite color?

2. What types of activities or situations make your child happy or excited?

3. What tends to make your child upset, anxious, or sad?

Future Aspirations

1. What does your child dream of becoming or achieving when they grow up?

2. Are there any specific goals your child has shared with you about their future?

Social and Emotional Development

1. How would you describe your child’s social skills (e.g., makes friends easily, shy in new situations, prefers to work alone, etc.)?

2. Does your child participate in any extracurricular activities or clubs? If so, please describe.

3. How does your child usually handle challenges or setbacks (e.g., gets frustrated, tries again, seeks help)?

Health and Well-Being

1. Does your child have any medical conditions, allergies, or dietary restrictions we should be aware of?

2. Are there any emotional or mental health considerations we should know about to better support your child?

3. Does your child require any specific accommodations to participate in our program?

Additional Information

1. Is there anything else you would like to share about your child that would help us provide the best possible experience for them?

2. Do you have any concerns or suggestions for us as we begin this mentorship journey with your child?

WESOURCE emphasizes the need for support and guidance to help children make informed educational decisions for their future. While 43% of adults currently work in their childhood dream jobs and 19% have done so previously, many young people lack the trust, love, and support necessary to take proactive steps toward their goals. This highlights the importance of early intervention and encouragement in shaping their futures.

Your gift today can help change a child's future.

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