Heart Connection Profile Card


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Heart Connection Profile Card Please fill in all blanks that apply to you.

Name

Birth date (month / day) City

Address Home Phone

 Engaged  Married (# yr.

Zip

Email Business Phone

Occupation  Single

/

)  Blended Family  Divorced (# yr

)  Widowed

Spouse’s Name Children’s Ages (M)

(F)

Grandchildren Yes/No

Have attended VCC since I want to be a:  Mentor Mentee  Either  Both I would like to be matched with: Hobbies, Interests, Gifts:

What I desire in a mentoring relationship is:

Is there anything in your life today that you feel would interfere with you being a mentor?

Is there anything in your life today that you feel would interfere with you being a mentee?

Please continue on the back of this card and share any personal or background information you feel would be helpful in making a mentoring match. Thank you and blessings!