Indiana Youth Institute: Mentoring Matters Registration

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Thank you for participating in Mentoring Matters.
Your efforts will make a great impact on mentors and mentees in Indiana!

Please complete the following form to register for
the Indiana Mentoring Partnership’s Mentoring Matters.

After your registration is completed, an IMP staff member will contact you with a link to
your fundraising page and directions on how to use your page.

Please Note: IMP must receive both mentor/mentees complete photo release form
before the fundraising page can be published.

You can email the completed form to vista_fdm@iyi.org or fax to 317-396-2701.
IMP staff will be in touch with you throughout the fundraiser to help you meet
your fundraising goals.

* - Denotes required field.

MENTORING ORGANIZATION INFORMATION
Organization:*
Address:*
Address 2:
City:*
State:*
Zip:*
County:*
Phone with area code:*
MENTOR INFORMATION:
Name of Mentor:*
Phone Number of Mentor with area code:*
Email of Mentor:*
Length of time as a mentor: *
Please note: the Mentor will serve as the primary contact for this fundraiser.
MENTEE INFORMATION:
Name of Mentee:*
Phone Number of Mentee with area code:*
Guardian’s Name:*
Mentee's Grade Level:*
Name of the School Mentee Attends:*
What are the Mentee's plans for post-secondary education? Apprenticeship Vocational School 2yr Degree 4yr Degree Other:
Tell us your story:
Don’t know what to say? Here are some questions to get you started… What made you want to be a mentor or mentee? How has being a mentor or mentee changed your life? What is the best part about being a mentor or mentee? How do you spend your time together? What do you want to do after high school? How will your mentor help you achieve that goal?
How long have you been working together?
What is your fundraising goal?	Please enter a dollar amount.
Download parent consent and photo release form here.
To complete your fundraising page please send a picture(s) of you and your mentee and/or a video describing your mentoring relationship to vista_fdm@iyi.org. The more content your page has the better!

CLICK THE SUBMIT BUTTON TO FINISH!

Please click on the submit button only ONCE!

(If you do not get a screen that confirms your submission please make sure you have filled out all of the required fields).

Find a Mentoring Opportunity
Zip Code:
Distance:
Location:

Program Type:

Ages of Youth Served:
7 and under 8-10 11-14 15-18 All of the Above