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903
903
Candidate Data:
First Name: 
John
Last Name: 
Smith

Date of Birth:

Age:

01

-

01

-

1969

10

School:

ABC School

Grade:

5th

Guardian Info:

First Name:

Mommy

Last Name:

Smith

Address:

123 Street

Manchester

NH 

03103

Guardian/Family Phone:

Guardian/Family Email Address:

Living Situation:

Single Mother

Financial Situation:

Medicaid:

Free/Reduced Lunch:

TANF:

SNAP:

How many live in the household?

2

How many work and/or provide income to support the household?

0

Household Situation:

Test.

Organizations / Mentor Programs:

Test.

Special Assistance:

Test.

Health Concerns:

Test.

Victim of Sexual Abuse:

Test.

Perpetrator of Sexual Abuse:

Test.

Victim of Physical Abuse:

Test.

Threatening or Aggressive Behavior:

Test.

Required Physical Restraint:

Test.

Personality / Social Standing:

Test.

Behavioral Patterns:

Test.

Remarks:

Test.

Mayhew challenges and helps at-risk New Hampshire boys to believe in themselves, work well with others, and find their best.

Address: Newfound Lake

P.O. Box 120
293 West Shore Rd
Bristol, NH  03222

Email: mayhew@mayhew.org

Phone: (603) 744-6131

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