Mentoring Registration Form

Scholars Info

* Indicates required field

Name *

First

Last

Date of Birth *

2019-20 academic grade/school *

Address *

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City

State

Zip Code

Country

Phone Number *

Email *

Allergies: *

Medications: *

Three words to describe you: *

Academic Goals: *

What are your hobbies? *

What do you enjoy learning? *

Parent/Guardian info

Name *

First

Last

Address *

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Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Relationship *

Emergency contact info

Name *

First

Last

Address *

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Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Relationship *

Do you have internet at home? *

Yes No

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

Yes No

Submit

Rev. Dr. Tracey Gibson, Pastor
Rev. Stacey Smith, Presiding Senior Elder
The Rt. Rev. Fredrick Alan Wright
Presiding Bishop

ST. PETER'S
African Methodist Episcopal Church
401 E. 41st Street, Minneapolis, Minnesota 55409
Phone: 612-825-9750
E-mail: [email protected]

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