Mentoring Registration Form

Scholars Info

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Name *

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Last

Date of Birth *

2019-20 academic grade/school *

Address *

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Phone Number *

Email *

Allergies: *

Medications: *

Three words to describe you: *

Academic Goals: *

What are your hobbies? *

What do you enjoy learning? *

Parent/Guardian info

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Last

Address *

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State

Zip Code

Country

Phone Number *

Email *

Relationship *

Emergency contact info

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Last

Address *

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Phone Number *

Email *

Relationship *

Do you have internet at home? *

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Would your family benefit from food distribution / drop off? *

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Submit

Rev. Dr. Tracey Gibson, Pastor
Rev. Stacey Smith, Presiding Senior Elder
The Rt. Rev. John Franklin White, Presiding Bishop

ST. PETER'S
African Methodist Episcopal Church
401 E. 41st Street, Minneapolis, Minnesota 55409
Phone: 612-825-9750
E-mail: stpetersame@msn.com

St. Peter's Office Hours
Monday 10:00 am - 2:00 pm
Tuesday - Thursday 10:00 am - 5:00 pm
Saturday - 10:00 AM - 2:00 PM