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Lockhart Cares Mentee Application

Thank you for your interest in referring youth to be mentored through our program! Please fill out the information below and we will follow up with you soon.

Please understand that filling out an application doesn't guarantee that you will be able to participate in the program and that even eligible applicants may have to be placed on a waiting list until we have a mentor that would be a good match. 

All mentees must consent to participate in the program; we do not take mandated clients. If you have any questions about who might be a good fit for the program, please contact our Mentor Coordinator at

We are excited about getting to know you!

Relationship to the Mentee:
Which of the following life challenges has this person faced?

Thanks for submitting!

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