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Navigators Mentoring Program
2026 Application 

Parent / Guardian Information

Gender
Marital Status
Single
Married
Divorce
Other
Does your family receive income assistance?
Yes
No
Does your family receive housing assistance (e.g. Section 8, residence in public housing?)
Yes
No

Student Information

Student's Date of Birth
Month
Day
Year
Does your child receive free/reduced lunch?
Yes
No
Do you have legal custody of the child?
Yes
No

Mentoring Outcomes Survey

This section should be completed by the student personally. Please note that this information will remain confidential and will not influence your child's admission into the program.

On your most recent report card, which of these describes your grades in these subjects?

Math
A (Excellent)
B (Good)
C (Okay)
D (Not Good)
F (Very Poor)
English / Language Arts
A (Excellent)
B (Good)
C (Okay)
D (Not Good)
F (Very Poor)
Social Studies / History
A (Excellent)
B (Good)
C (Okay)
D (Not Good)
F (Very Poor)
Science
A (Excellent)
B (Good)
C (Okay)
D (Not Good)
F (Very Poor)

Do you think you will finish high school?

Single choice
Yes
No
Unsure

Do you plan on attending college or trade school?

Single choice
Yes
No
Unsure

How often do you get in trouble for:

Bothering / not listening to my teacher.
Never
Sometimes
A lot
Breaking school rules.
Never
Sometimes
A lot
Not following directions.
Never
Sometimes
A lot
Breaking other people's things
Never
Sometimes
A lot
Lying to parents or teachers
Never
Sometimes
A lot
Taking something without permission.
Never
Sometimes
A lot

How often do you:

Skip school without permission
Never
Sometimes
A lot
Get high using prescription or illegal drugs or substances
Never
Sometimes
A lot
Not following directions.
Never
Sometimes
A lot
Drink alcohol
Never
Sometimes
A lot
Run away from home
Never
Sometimes
A lot
Participate in a gang
Never
Sometimes
A lot
Get stopped by the police for something they thought you did.
Never
Sometimes
A lot
Get sent to detention.
Never
Sometimes
A lot
Work well with other kids at school.
Never
Sometimes
A lot
Get along with your parents.
Never
Sometimes
A lot
Keep your feelings from getting out of control.
Never
Sometimes
A lot
Control yourself when you get angry.
Never
Sometimes
A lot

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Contact Us

We value your engagement and are eager to hear from you. Whether you have questions, want to collaborate, or simply wish to share your thoughts, our team at the Bridge Builder Collective is here for you.

Thanks for submitting!

ADDRESS

9515 Lee Hwy

STE B #163

Ooltewah, TN 37363

EMAIL

contact@bridgebuildercollective.org

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