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NOMINATE A PROTÉGÉ

The Shirley Chisholm Education Foundation mentoring Program appreciates your interest in becoming a protégé in the Protégé Experience mentoring program. Please complete and submit the following form to begin the application process.

First Name*

Last Name*

Age

Highest Level of Education

Phone Number

Email Address

Current Educational Institution/Not Applicable

Referred by

Name*

Phone Number

Email Address*

This young adult is being referred for assistance in the following areas (check all that apply):
Academic IssuesBehavioral IssuesSelf-DevelopmentLeadership SkillsSelf-EsteemStudy HabitsSocial SkillsPeer RelationshipsFamily IssuesFinancial LiteracyAttitudeOther (please specify)

Other

* required fields

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