100 Black Men of Greater Kansas City 100 POP Mentoring Program

Parent or Legal Guardian Participant Profile

This document is to be completed by the parental guardian of the prospective youth participant. This document is in no way an application of acceptance into The 100 POP Mentoring Program. Your profile will be maintained as confidential.

100 POP Parent Form

* Parents or Legal Guardians:

* Son's Name(s):

* Address:

* Email Address:

* Home Phone:

* Mobile Phone:

* Name of School:

* His favorite subjects:

* What school activities or youth groups is he involved with: (i.e. After-School Clubs, Church Groups, Sports)

* What study habits can we enhance?

* What school subjects can we help your son with?

* In your opinion what social skills need refinement?

* Has he shared his life goals with you? If so, what are they?

* What are his Favorite Foods:

* What types of Music does he like?

* Are there any medical conditions we should be aware of? If so, please list them.

* Indicates Response Required

Report Abuse

Thank you for taking the time to fill out this profile. The 100 Black Men of Greater Kansas City is committed to ensuring that all information regarding a youth participant will be treated as confidential. All forms should be submitted ONLY to the 100 Black Men of Greater Kansas City, PO Box 12500, Kansas City, KS 66112. Visit us at: http://100blackmenkc.org/ or email us at: 100blackmenkc@gmail.com