New Horizons Mentorship Form

MENTORSHIP INFORMATION FORM

Name of student: 
                          (Last)             (First)  (Middle)

High School:          Age: 

Home address: (street, city, state, zip)


Home Phone:     Emergency Phone: 

I will be a  next fall.

AREA OF MENTORSHIP INTEREST: Choose from the following list or state your own area of interest. The mentorship must be science oriented. Please be sure to type your choice in the following three boxes. You may wish to include a desired site or site specifications. Note that if you have already chosen a mentor, fill in the first choice with your mentorship topic, your mentor's name, your mentor's address, and your mentor's phone number.

1st choice: 2nd choice: 3rd choice:

Options listing:

PROGRAMMING LANGUAGES: Please list all the computer languages in which you can program (be sure to type them in the box below).

Parents/Students: Please let us know if there are any special circumstances that we need to consider when setting up your mentorship.

ESSAY TOPIC: To aid us in matching you properly with a mentor, we request that you first do some research on your own about your area of interest. After studying library resources, please answer the following questions in essay form keeping in mind that a potential mentor will read your essay to decide whether or not he/she wants to work with you. Your placement depends greatly on this essay. Please type your essay and print out a copy, sending it to Sue Greiner along with this form.

Once you have finished filling out this form, click on the 'Submit Form' button below to continue.