PARTNER UPA Mentoring Program for Prospective First-Generation U.S. College Students Student Name First Name Last Name Current Grade Date of Birth MM DD YYYY Preferred Pronouns Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email Cell Number Best Way to Reach You? Email, Text, Whatsapp, Etc. Parent or Guardian Name First Name Last Name Relationship Parent or Guardian Cell Number Referred By Please name the advisor or an organization What paths are you considering after high school? You may check more than one 2 Year College 4 year College Other (please specify below) If you selected "Other", please explain If you are planning a 4 year college, which college majors are you considering? Have you discussed your plans in depth with a guidance counselor, parent or teacher? If yes, please specify with whom Why are you interested in having a mentor? What qualities do you feel are important for your mentor to possess? Are you working? If so, how often and where? What are your favorite subjects in school? What is your current GPA? A copy of your transcript or report cards for 9th and 10th grades will be required at interviews Are there any subjects you need help with? If yes, please specify. What activities or clubs/organizations are you involved with? How much time commitment is involved in all the activities, clubs and organizations? 1 to 3 times a week 3 to 6 times a week Every day What are your favorite hobbies or interests? Do you anticipate any difficulties in meeting with your mentor 1 or two times a month and maintaining regular phone and/or text contact at least once weekly? Do you have people in your life who are supportive of your plans to go to college? Have you thought about the financial aspect of attending college, paying for tuition, room and board, books? If yes, how would you pay for it? Loan Scholarship Parents Work Is there anything else you feel would be important for us to know about you (awards, commendation, family circumstances, etc.) If you are accepted into Partner Up, do you give your consent to share this application form with your mentor? Your answer will not impact your acceptance one way or the other I certify that the information provided is true and accurate. I also certify that I am fully committed to my success in the Partner Up Mentor Program I Agree I Do Not Agree Parent or Guardian Email Parent/guardian email is required because we must secure consent from your parent/guardian for you to participate in this program. Thank you! Your application has been received. We will get back to you.
