THE RISING START PROGRAM – STUDENT MENTOR AND TRAINER APPLICATION

Thank you for your interest in becoming a mentor and trainer with the Rising Star Center for Neurodiverse Innovation & Entrepreneurship! Please complete this application to help us understand your background, interests, and commitment to the program.

NAME NAME First Last
DATE OF BIRTH DATE OF BIRTH / MM / DD YYYY
Phone Phone - ### - ### ####
Email Address
CURRENT SCHOOL/ UNIVERSITY
MAJOR / FIELD OF STUDY
EXPECTED GRADUATION EXPECTED GRADUATION / MM / DD YYYY
1. Do you have any prior mentoring, tutoring, or teaching experience?
If yes, please describe:
2. Have you ever participated in any leadership or volunteer programs?
If yes, please explain:
3.What skills or expertise do you bring to the program?
4. Do you have any experience with entrepreneurship or innovation?
If yes, please share:
PROGRAM GOALS
1. Why do you want to become a mentor and trainer with our program?
2.What do you hope to gain from this experience?
3. How do you plan to inspire and guide the young entrepreneurs in the program?
AVAILABILITY

Please indicate which semester(s) you are available to serve as a mentor or trainer. If you are available for more than one semester, kindly specify in the "Other" field.
Please indicate which semester(s) you are available to serve as a mentor or trainer. If you are available for more than one semester, kindly specify in the "Other" field

Please indicate which semester(s) you are available to serve as a mentor or trainer. If you are available for more than one semester, kindly specify in the "Other" field Spring Summer Fall Other Other
2. Please indicate which day(s) you are available to serve as a mentor or trainer. If you are available for more than one day, kindly specify in the "Other" field.

2. Please indicate which day(s) you are available to serve as a mentor or trainer. If you are available for more than one day, kindly specify in the "Other" field. Monday Tuesday Wednesday Thursday Friday Other Other
REFERENCES

Please provide the contact information for two references who can speak to your qualifications.
Name Name First Last
Relationship
Phone Phone - ### - ### ####
Email
Name Name First Last
Relationship
Phone Phone - ### - ### ####
Email
SIGNATURE

Draw or Type

By signing below, I confirm that the information provided in this application is accurate and complete to the best of my knowledge. I understand that submitting this application does not guarantee acceptance into the program. Clear

Full Name

By signing below, I confirm that the information provided in this application is accurate and complete to the best of my knowledge. I understand that submitting this application does not guarantee acceptance into the program.

THE RISING START PROGRAM – STUDENT MENTOR AND TRAINER APPLICATION

THE RISING START PROGRAM – STUDENT MENTOR AND TRAINER APPLICATION

PROGRAM GOALS

AVAILABILITY

REFERENCES