Alo Bloom Academy Sign Up

Rather than selecting a mentorship package right away, we begin by getting to know you.
Fill out the form below, and Kalayna will review your needs to help guide you toward the right type of support.

Parent / Guardian Information

Parent/Guardian First Name*

Parent/Guardian Last Name*

Email*

Phone*

Mentee Information

Mentee First Name*

Mentee Last Name*

Mentee identifies as*

Boy

Girl

Young Adult

Mentee Age*

Mentee Grade (if applicable)

Mentee Background

How long has your child been navigating alopecia?*

Recently diagnosed

Under 1 year

1–3 years

3+ years

Growth & Inner Work

What are a few areas you would like your child to grow in through mentorship? *

(Examples: confidence, self-expression, communication, emotional awareness, self-advocacy, resilience)

What inner skills would you like your child to strengthen?*

(Examples: self-worth, identity, emotional regulation, trusting themselves, handling social situations)

Current Challenges (Mentee Experience)

What challenges does your child currently face related to alopecia?*

(Examples: school, social settings, self-image, confidence, peer interactions)

Program Fit

What made you interested in Alo Bloom Academy for your child?*

Would you be open to a follow-up conversation to ensure this program is the right fit for your child?*

Yes

Maybe

Not at this time

Is there anything important about your child that would be helpful for me to know as a mentor?

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