2018-2019 Application: IAM Mentoring for High School Students
Thank you for your interest in the IAM Mentoring for High School Students program. Please complete the below application before Friday, October 12. Our first day of program and student orientation is on Thursday, October 18. Sessions are held on Thursdays from 5:30PM - 7:30PM until May 23, 2019. All applicants and their parents will be notified via email and phone prior to that date about their participation in the program.

Returning students are required to complete this application as well.

If you have any questions, please email fharris@influencingaction.org.

Are you a returning student or new student? *
Student First Name *
Your answer
Student Last Name *
Your answer
Student Phone Number *
Your answer
Student Email Address *
Your answer
Grade *
School currently attending *
Your answer
Mailing Address *
Street portion only. Example: 30 S. 15th Street
Your answer
City *
Please write out full names. Example: Philadelphia
Your answer
State *
Use initial. Example: PA
Your answer
Zip Code *
Your answer
Parent/Guardian Name *
Who should be copied on emails about the program?
Your answer
Parent/Guardian Email Address *
Who should be copied on emails about the program?
Your answer
Parent/Guardian Phone Number *
We will call your guardian to discuss the program application and seek approval for your participation.
Your answer
Majority of program sessions are held at Temple University main campus, do you have reliable transportation to get to this location? *
Majority of session are held on Thursday from 5:30PM - 7:30PM, will being on time and staying for the session be a challenge? *
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