Start Her Application

Please complete this interest form as the first step. Once submitted, we will review your daughter's needs before processing the $400 mentorship program payment.

Anchor & Bloom Mentorship Interest Form

We're so glad you're interested in our 6-week virtual mentorship program! The journey begins the week of June 16, with group sessions held every Tuesday. Our program is designed for girls ages 14–18, with separate groups for ages 14–16 and 17–18 to ensure age-appropriate mentorship. Please share a bit about yourself and your daughter so we can ensure this is the perfect fit.

Parent First Name

Parent Last Name

Parent Email Address

Phone Number

Teen’s Name

Daughter’s Age Group

Ages 14–16

Ages 17–18

Daughter’s Exact Age

How Did You Hear About the Program?

We would love to send your daughter a special welcome box to kick off her journey with us! Please provide your mailing address below so we can get that delivered to her.

Mailing Address (for your daughter’s welcome box)

Country/Region

Address

City

Zip / Postal code

What do you hope your daughter will gain from this mentorship?

Current Concerns

This helps the mentor tailor the experience to her needs.

Preferred Weeks/Dates for 1:1 Sessions

Please choose a few options from the following available date ranges for your 30-minute 1:1 sessions: June 22–26, June 29–July 3, July 6–10, July 13–17, July 20–25, and July 27–29. It is important to select from these specific weeks only to ensure mentor availability. Please add preferred times between 10am-6pm. Group sessions meet on Tuesdays from 6:30–7:45 PM ET.

Anything Else the Mentor Should Know?

Start Her Application

Anchor & Bloom Mentorship Interest Form

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