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Private Mentorship
Registration & Assessment
Form

Welcome to our Private Mentorship Registration & Assessment Form. This comprehensive form is designed to understand your unique needs and expectations for our mentorship program. Your input is invaluable as it covers essential aspects like personal information, your objectives, challenges you may be facing, preferred learning styles, concerns, and your desired schedule.

Please don't worry if some sections feel like a lot to fill out. Just complete what you can; there's no pressure to provide everything. Your responses enable us to create a tailored mentoring plan aligned with your goals. Additionally, we offer a Private Mentorship Personality Test to gain insights into personality traits, enhancing the guidance we provide.

This form is a pivotal step towards nurturing growth and aspirations through personalized mentorship. Take your time with it, as it lays the foundation for an enriching mentorship journey. Thank you for choosing our Private Mentorship Program.

Please enter your first name.

Parents last name

Please enter child's first name.

Childs last name

Please provide your child's age. (Child's current age to help us tailor mentorship)

Please select the English proficiency level that best describes the individual:

Kindly provide the name of your first language or your child's first language. This information helps us understand your linguistic background and better tailor our mentoring services to your needs.

Please provide your email address.

Please provide a phone number where we can reach you.

Describe your academic goals or expectations. Are there specific subjects or skills you want to improve academically?

Outline your expectations regarding interpersonal skills. Please describe any specific social or communication goals.

Share any challenges you or your child currently face. What difficulties or obstacles would you like to address?

Let us know the preferred learning style for your child. Does your child learn best through visuals, auditory cues, or hands-on experiences?

Feel free to add any other comments or concerns. Is there anything else you'd like to share or discuss?

If you have a preferred schedule in mind, please specify. If you already have specific days or times in mind, kindly mention them.

Provide an emergency contact person and their contact number. In case of emergencies, please provide a reliable contact.

Share any allergies or medical conditions, if applicable. For safety purposes, please inform us of any allergies or medical concerns.

Specify your preferred language for communication. What language do you prefer for mentorship sessions and communication?

Share any challenges you or your child currently face. What difficulties or obstacles would you like to address?

Will you need a Progress Report Letter and a Family Court Reference Letter from Private Mentorship? Note: Our clients in family court situations often request these letters, provided free in all packages. Enhance your court presentation, showing your commitment to your child's development.

Please indicate your preference regarding your child's phone usage during mentorship sessions. We value your input, and understanding your preferences helps us create the best learning environment for your child. Please select the level that aligns with your expectations:

Level 0: No phone usage during mentorship sessions. My child should have zero distractions.

Level 1: Minimal phone usage is acceptable. My child may need occasional access for emergencies only.

Level 2: Limited phone usage is allowed during breaks or for urgent matters.

Level 3: Moderate phone usage is permitted, but it should not disrupt the mentorship session.

Level 4: Higher phone usage is acceptable, as long as it doesn't interfere significantly with the mentorship session.

Full phone usage is allowed during mentorship sessions. My child can multitask effectively.

Please acknowledge your approval for the appropriate level of physical training for yourself or your child. It's essential to ensure that the physical training level aligns with your or your child's health and fitness goals. Please check the box below to indicate your approval:

Level 0: No exercise is recommended.

Level 1: Limited exercise is suitable.

Level 2: Mild exercise is appropriate.

Level 3: Moderate exercise is acceptable.

Level 4: High-intensity exercise is approved.

Level 5: Feel free to engage in any desired level of exercise.

Private Mentorship Personality Test Note: This test should be completed by the child alone. If the child requires assistance due to age or specific needs, please provide the necessary support.

Todays Date

I agree to the terms & conditions

Thanks for registering.