Register
  • Are you a teen girl between the ages of 12-17?
  • Do you face challenges in your own life and sometimes not know where to turn?
  • Are you looking for an adult that you can share and communicate with without fear of being judged?    

SWAGG is your solution!  With SWAGG, you will be matched with a mentor, a woman who may have grown up a lot like you.  This mentor will be reachable via email and by phone if you so choose to talk to, offer advice, and just lend an ear to listen.  You will also be able to meet and network with other teen girls by creating your own online profile. 

If you are interested in becoming a part of SWAGG, please complete our simple application form below.  Someone will get in touch with you within 48 hours to complete your registration process.  Please note:  A Parent/Guardian Consent Form must be signed by a parent or guardian and mailed or faxed back to us prior to final acceptance into the program.  Click here to get the form.
S.W.A.G.G. Mentorship Program Youth Questionnaire

Personal Information:

First name:                                    Middle initial:          Last name:

Date of Birth:


Contact Information:

Home Address:                                                                                 Apt #:

City:                                                              State:                  Zip Code:

Home Phone:                                      Alternate Phone:

E-Mail:

Emergency Contact Phone:

Language of Preference:

Current School (If attending otherwise please list last school attended and date you last attended.)


For any areas below where you may have a basic need, please indicate a description of your current needs.

Housing:




Clothing:




Finances:




Transportation:




Career Development:




Health:





Other:




For each issue below that applies, please provide a description and as much detail as possible in the following areas.

Substance Abuse Issues:




Self-Esteem (Low, Medium, High):




Mental Health Issues:




Medications:




Other:





Please provide some additional personal information about yourself in the areas listed below.

Family:




Social Support:




Other:




Please give us some details as to what you consider some or your strengths and/or your barriers in the following areas.

Educational:




Career:




Health/Well-Being:




Social:




Spiritual:




Other:





Career Interests:
Please check any Occupational Category(s) you are interested in:

   

   

   

   

   

   

   

   

   

     



What in you life makes you feel interested or in need of having a mentor? 







Do you have any personal emergency situation for which you are in need of immediate assistance? If so, please explain.







Are you now, or have you ever been a victim of domestic violence?







Are you looking for any special assistance or training?  If yes, in what area?







Do you have any hobbies or special interests?







What careers are you interested in?







Preference ranking:
List the qualities you would like in a mentor, starting with the most important.








Statement of Confidentiality

S.W.A.G.G. recognizes the right to the confidentiality and privacy of our participants and volunteers, and is dedicated to conducting business in only the highest ethical standards.

S.W.A.G.G. is committed to protecting the privacy of its participants and volunteers.  All information and disclosures will remain confidential and will be used only for the purpose of facilitating an appropriate Mentor/Mentee match.  Any information disclosed through this mentor relationship will remain confidential and will not be discussed with anyone.



Applicant Electronic Signature



Date

BECOME A MENTOR
If you are over the age of 18 and willing to volunteer some of your time to one of the teen participants in our program, please
CLICK HERE TO REGISTER.
SWAGG is no longer just a word...it's a movement!
Management
Business, Finance, and Administration
Health
Social Service, Education, Government Service, Religion
Art, Culture, Recreation, Sport
Sales & Service
Trades, Transport, Equipment Operators
Primary Industry
Processing, Manufacturing, Utilities
Other (Please List)