Sign Up Form

Note: Required fields are marked with an asterisk (*)

PERSONAL INFORMATION First Name *
Last Name *
Address *
Address 2
City *
State *
Zip *
Day Phone
Evening Phone
E-mail *

FEEDBACK

Are you currently a college/university student? Yes No

If yes. Which college/university?

What is your major?
Occupation
Company

I would like to be a (please check one)

Mentor
Tutor

Please tell us why you're interested in Mentoring/Tutoring?

REFERENCES Personal Reference
Full Name
Phone

Professional Reference
Full Name
Phone

PERSONAL QUESTIONS Answers to these questions will help us pair you up with a Scholar.

1. Education: Where you went to school, degree(s), future plans, etc.

2. Work Experience: Where do you work (where have you worked?)? What do you do?

3. How would you describe your academic experience in middle and high school?

4. Please describe any teaching or tutoring experiences you've had, either with Steppingstone or another program.

5. What are some of your personal interests?

6. What do you think children need in order to succeed in school?

7. What are your concerns about being a Mentor/Tutor?

8. How did you hear about Steppingstone Scholars?

9. Would you be interested in helping out with development events (i.e.: fund raising)?