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Dr. V The Speaker

Youth Mentoring Interest Form

Parent/Guardian Information:

First name

Last name

Email

Phone

Youth Information:

Youth Full Name

Birthday

Month

Day

Year

Gender:

Male

Female

Non-binary

Prefer not to say

Siblings to be Mentored (if any):

Location:

City

State

Country

Area of Mentorship Focus:

Multi choice

Academic Achievement

Personal Development

Leadership Skills

Career Guidance

Sports & Physical Development

Social Skills & Networking

Confidence Building

Other

Additional Comments or Questions:

I understand that this is an application process for Mentor Me by Dr. V and does not guarantee a spot in the mentorship program.

Spring/Summer Tour Highlights

Consider seeking out a mentor today and see how it can benefit you.

Mentorship

/'men(t)er,SHip/

noun

the guidance provided by a mentor, especially an experienced person in a company or educational institution.

Text Me!

Personally
Text Dr. V!

Hello everyone, just a quick heads-up that you can now text me at 419-909-6196 to stay connected. Whether it's for work-related matters or just to say hello, feel free to reach out via text. Looking forward to staying in touch with all of you!

Dr. V The Speaker

Contact: booking@DrVTheSpeaker.com | Phone: 877-358-7255

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