Junior Mentorship Mentee Application

Thank you for your interest in becoming a mentor in the Junior Mentoring Program!

Founded in 2005, the Mentorship Program has provided an open and safe space for tweens and teens to connect with each other and older adoptees through various events throughout the calendar school year. Through events focused on the conversation of adoption, we allow for mentees to learn from our mentors, share their experiences with one another and meet their adopted peers.

This program is designed to bridge the gap for those between Play Cafe and Mentorship age. The Junior Mentoring program engages age appropriate discussions about friends, family, identity, growth, adoption, and the adoptee experience at our Spence-Chapin offices and virtually via Zoom. Our Junior Mentorship program, on average has 8-10 adoptees ages 10-12 years old and is facilitated by Spence-Chapin staff and adoptee mentors 25 and over.

Our group meets one Saturday each month September-June from 11am-1pm, Junior mentorship is designed to provide space for conversation, team building, and community building in a fun immersive setting. There is also a parent group that meets once monthly on Thursday also 6-7:30pm. In both groups we discuss topics surrounding adoption, and the adoptee, and adoptive parent experiences, while also incorporating fun activities and games to bond our group.

All our mentors are trained and screened by Spence-Chapin staff.

Once your application is received and reviewed, the program lead will call to set up an in-person family interview here at our office.

Please Note: Incomplete applications will not be accepted; please complete all required fields.

Mentee Applicant

First Name of Child*

Middle Name of Child

Last Name of Child*

DOB*

Child's Preferred Pronouns

Child's Gender*

Grade Youth is Currently In*

Child's Place of Birth*

Child's Age When Adopted*

Was your adoption completed through Spence-Chapin?*

Yes

Youth Email

Parent(s) & Contact Info

Full Name of Parent 1*

Parent 1 Email*

Parent 1 Cell Phone*

Enter International

Full Name of Parent 2

Parent 2 Email

Parent 2 Cell Phone

Enter International

Home Phone

Enter International

Primary Street Address*

Primary Street Address Line 2

Primary City*

Primary State/Region*

Enter Region

Primary Zip Code*

Country

How did you hear about our program?

How did you hear about our program at Spence-Chapin?*

Application Questions

SHOULD BE COMPLETED BY A PARENT:

Please tell us about your child’s personality, including the strengths and challenges they experience socially and behaviorally (at home and in school).*

What do you hope your child will gain in the mentorship program?*

Has your child ever expressed an interest in finding a mentorship or community-based group that focuses on adoption?*

Is there anything else you would like us to know about your child?*

Adoption/Family Questions

SHOULD BE COMPLETED BY A PARENT:

Please briefly tell us about your child’s adoption. At what age were they adopted, and from what state or country?*

Please tell us who is in your family. Include any recent family changes (divorce, birth, death, move, etc.). When listing children, please indicate if they are biological or adopted.*

What is your child’s understanding of their adoption story and identity? Are they comfortable speaking about adoption with others?*

Have you or your child had contact with their biological family, either previous or ongoing? Please explain.*

Please describe how your family talks about and incorporates adoption. Include any adoption-focused trips, programs, camps, etc. that your family has been a part of.*

Medical History

SHOULD BE COMPLETED BY A PARENT.

Does your child have any physical limitations or are they currently receiving treatment for any medical conditions or other challenges? If yes, please explain.*

Is your child currently on any type of medication? If yes, please explain.*

Does your child have any emotional considerations? If yes, please explain.*

Does your child have any allergies or adverse reactions to medications? If yes, please explain.*

Does your child have any dietary restrictions (include vegetarian or vegan)? If yes, please explain.*

Complete this Application

All the information provided as part of this application is true to the extent of my knowledge. I understand that by submitting an application, this solely does not guarantee my child will be accepted into the Program.

Applicant Signature*

Application Signed Date*

Mentee Questions

THE FOLLOWING SECTION SHOULD BE COMPLETED BY THE MENTEE:

What are your hobbies, interests, and/or special skills?*

Do you enjoy meeting new people and making new friends?*

Do you feel comfortable speaking about your adoption with others? If so, with whom?*

How often do you think about your adoption identity? Not at all?*

Do you know any other kids or adults who are adopted?*

What do you hope to get out of participating in the Mentorship Program?*

Is there anything else you would like us to know?*

Once your application is received you will receive a call from Jessica M. Luciere, Community Engagements Associate Director.

Submit

Spence-Chapin promotes equal opportunity for all applicants. In doing so, we comply with local, state, and federal laws and regulations to ensure an equal opportunity for everyone. Spence-Chapin does not discriminate on the basis of race, ancestry, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, citizenship, military service obligation, veteran status or any other basis protected by federal, state or local laws.