InnoWorks

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 Leadership Summit: 2010 TBD	Yes No
University of Arizona: July 9 - July 11, 2010	Yes No
College of the Bahamas: June 28 - July 2, 2010	Yes No
Duke University: August 16 - August 20, 2010	Yes No
University of Maryland College Park: August 16 - August 20, 2010	Yes No
University of Michigan: August 16 - August 20, 2010	Yes No
University of Pennsylvania: August 30 - September 3, 2010	Yes No
University of Maryland Baltimore County: 2010 TBD	Yes No
Effat College, Jeddah, Saudi Arabia: TBD	Yes No
Georgetown University: TBD	Yes No
Universtiy of California, Los Angeles: Summer 2011	Yes No
Boston University: July 26 - July 30, 2010	Yes No
MIT: August 9 - August 13, 2010	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?

Mentor and Staff Application Form

InnoWorks is a Winner of the 2007 BRICK Awards