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803) 234-9152
Proverbs 22:6
Train up a child in the way he should go and when he is old, he will not depart
REP Mentee Referral Form
Student's First Name
Student's Last Name
Age
Grade
School
Name of Parent /Gaudian
Parent/Gaudian Phone
Email Address
Requested by:
Phone
What areas does the student need assiatace? (Choose all that apply)
Academic
Self-Esteem
Family Issues
Behavioral Issues
Study Habits
Special Needs
Delinquency
Social Skills
Attitude
Vocational Training
Peer Relations
Other
Please deescribe the student.( Please tell us his or her likes, place to go, type of music lestens to, etc...
Tell us why do you fell this student might benefit from a mentor?
Submit Form
Thank you for the referral.
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