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GEAR UP MENTOR APPLICATION 2013-2014

Name Address City/State/Zip Date of Birth: Home Phone:

E-mail: Facebook: Twitter: T-shirt Size Cell Phone: c Yes c Yes c S c No c No c M c L c XL

Grade:

Academy: __________________

Date: ___________________

Please tell us a little about yourself.


Why do you want to be a mentor?

What do you think makes a good mentor?

I, _____________________________________________, promise to follow these rules of mentoring: c I will attend all Mentor trainings and activities c I will do well in school and serve as a positive role model c I will share my college knowledge with my peers c I will keep my parents up-to-date with the Mentor program c I will get a teacher recommendation that I am in good academic standing
Student Signature: ________________________________________ Date _____________________

This box is for GEAR UP only Student's Record Number: _________


Fall GPA ________ Spring GPA ________

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