Mentoring Application

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Parent/Guardian First name*

Parent/Guardian Last name*

Parent/ Guardian Email*

Parent/ Guardian Phone Number *

Preferred Contact Method

Dropdown

Child's Full Name*

Child's Date Of Birth *

Month

Day

Year

Child's Age

Child's Grade*

School

Program Focus Area

Social Skills & Peer Relationships

Confidence & Self-Esteem

Emotional Wellness

Life Skills & Goal Setting

This is a checkbox.

Emergency Contact Name *

Emergency Contact Phone Number

Allergies, Medical Conditions, or Behavioral Needs (if any)*

I give permission for my child to participate in mentoring services through How Well Is Well Enough.

I understand that submission of this application does not guarantee immediate placement and that I may be contacted for additional intake steps.

I understand that all information provided will be kept confidential.

Mentoring Application & Intake

Thank you for your interest in How Well Is Well Enough . Our mentoring program supports youth through holistic wellness, personal growth, and positive relationships. Please complete the application below to begin the enrollment process once submitted our team will contact you with next steps.

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