Mentor and Staff Application Form

First Name
Last Name

School Address
Address
 
City
State Zip Code

Home Address
Address
 
City
State Zip Code

Year in School
Major(s)

Best phone number to contact you
Email Address

What are your summer plans and when will you be available to help with program preparation? Please be as specific as possible and include evening availability.

Are you interested in being a mentor or staff member?

Mentors must be full-time during the program and work with a team of 4 students throughout the program duration. Staff members have more flexible duties and do not necessarily need to be full-time. Jobs may include running stations, teaching program modules, troubleshooting problems, assisting mentors, preparing lunch and lunchtime activities, etc.

Which Chapter are you interested in joining?

I am interested in starting a new IW Chapter at

Will you be able to attend the following required events?

Participation in one program is necessary, but if you are interested in helping at other chapters, please let us know.
International Mentor Training – Summer 2007 TBD Yes No
Univ. of Arizona 2007 – July 11 - July 20, 2007 Yes No
College of the Bahamas 2007 –June 25 - June 30, 2007 Yes No
Duke University 2007 – August 6 - 17, 2007 Yes No
University of Maryland College Park 2007 – July 9 - July 13, 2007 Yes No
University of Pennsylvania 2007 – August 27 - August 31, 2007 Yes No
University of Maryland Baltimore County 2007 – Summer 2007 TBD Yes No
Effat College, Jeddah, Saudi Arabia – Summer 2007 TBD Yes No
Georgetown University – Summer 2007 TBD Yes No

Will you be able to find your own housing for these dates (if yes, please explain)?

Why are you interested in volunteering as a mentor with InnoWorks?

What experience do you have in working with children? Please indicate the ages you have worked with and in what capacity (mentoring, babysitting, coaching, etc.).

How do you feel you can contribute to this program?

What are you hoping to gain from being a mentor?

How did you hear about the InnoWorks program?