Home
About
Our Mission/Vision
Our Mentors
Our Centers
Our Programs
Projects
TJJD - NV
Bravefest 19
Summer Indulge
Get Involved
Community Partnership
Join Us
Events
Contact
Donate
Menu
PO Box 660252
Austin, TX 78766
18882995977
The SID Centers
Your Custom Text Here
Home
About
Our Mission/Vision
Our Mentors
Our Centers
Our Programs
Projects
TJJD - NV
Bravefest 19
Summer Indulge
Get Involved
Community Partnership
Join Us
Events
Contact
Donate
Potential Student Screening Intake Form
admin, please complete this P.m.s. intake form throughly & thoughtfully. The overall goal is to get to know our future mentors! Please check mark this section in the mentor onboarding doc.
Your Name
*
First Name
Last Name
SID Email
*
Todays Date
*
Date which P.M.S. is occurring
MM
DD
YYYY
Did you mention this call is being recorded?
*
Yes
No
Applicant Information Review
Please VERIFY This Information with them before moving to the next section.
Name
*
First Name
Last Name
SCC
*
208 (LA County)
210 (Orange County - CA)
212 (Clark County)
222 (Dallas Area)
223 (Fort Worth Area)
224 (Travis County)
225 (Williamson County)
264/265 (Wake County)
270 (Fulton County)
274 (Orange County - FL)
276 (Broward County)
Date of Birth
MM
DD
YYYY
Email
Phone
(###)
###
####
Home Address
VERIFIED?
*
YES
NO
QUESTIONS:
What is it that you really want to do and be?
*
What are you doing really well that is helping you get there?
*
What are you not doing well that is preventing you from getting there?
*
Who is the person in your life that you are closest to?
*
How would this person describe your personality?
*
What would others say that they do not like about you?
*
How do you spend most of your time?
*
Where would you like to be in the next year?
*
What area of your life do you need the most help? Explain.
*
How have you handled failure or setbacks in your life?
*
How would your close family or friends describe your personality?
*
Yes/No
Is there anything in your past that has helped shaped you?
*
What is your preferred communication style?
*
Anything else you'd like to mention?
*
Or use this section as notes
How long did this session take?
*
15-30 min
31-45 min
46-60 min
61-90 min
Thank you for this update!