EmailMe Form - Altus Academy Volunteer Application

Altus Academy Volunteer Application

Altus Academy is a private, independent, college preparatory middle school that is driven by the goal of fostering a culture of character. Key to this goal is to teach our students how to build positive relationships with caring adults that will help them envision a path to success; mentors at Altus Academy will make a deep‐rooted, long‐lasting impact.

COMMITMENTS:
Academic Mentors
* 1.5 hours per week at Altus Academy
for one academic year

Long-Term Mentors
* 30 minutes per week via technology (Google Hangouts/phone)
* Monthly notes via email.
* Occasional mentor training
* Events at Altus Academy
for a life-long mentoring relationship

Name *
Prefix First Last Suffix
Date of Birth
MM / DD / YYYY
Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Cell Phone *
### - ### - ####
Alternate Phone
### - ### - ####
Email (gmail is preferred) *
Race or Ethnicity
American Indian/Alaskan Native
Asian/Pacific Islander
Black/African American
Hispanic/Latino
I do not associate with any racial category
Multi-Racial
Other
White/Caucasian
Gender *
Female
Male
Highest Level of Education *
Current High School Student
High School Diploma
Current College Student
College Degree
Graduate or Professional Degree
List Schools Attended and Degrees Obtained *

High School

College/University

Graduate Professional
Current Employer (if applicable)
Current Occupation *
Resume
Work Reference: Please provide contact information for a co-worker or supervisor
Name *
First Last
Phone *
### - ### - ####
Email
Personal Reference: Please provide contact information for a close relative or spouse/significant other
Name *
First Last
Primary Phone *
### - ### - ####
Email
Emergency Contact Information
Em.Name *
First Last
Em.Primary Phone *
### - ### - ####
Em.Alternate Phone
### - ### - ####
Em.Email
Em.Relationship *
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High School
College/University
Graduate Professional

Work Reference: Please provide contact information for a co-worker or supervisor

Personal Reference: Please provide contact information for a close relative or spouse/significant other

Emergency Contact Information