CHAMP Mentor Returner Application 2021-2022
Please fill out this form if you have participated as a Mentor at Dilworth Elementary - Latta Campus in the year(s) prior. You will receive an email from the CHAMP Leadership Team confirming your acceptance.

Keep in mind, you MUST attend the CHAMP training on September 13 at 4:00 pm at MPUMC prior to the first day of the Fall Semester. Spring training date TBD. You will also be signing up to ride the vans 2 Mondays out of the semester at the training.

Thank you for being a great asset to the CHAMP program! We are so excited to be back for a great year!
Name *
Number *
Email *
Grade Level (2021-2022) *
When are you available? *
Who was your buddy last year? *
How was your relationship with your buddy? *
Would you like to keep the same buddy if possible? *
Why is CHAMP important to you? *
I acknowledge Dilworth CHAMP is a commitment for every Monday afternoon from 3:00pm until 5:30 pm at Dilworth Elementary - Latta Campus. I understand I have made a promise to be present and attentive each week. *
I acknowledge that homework, schoolwork, midterms/finals, or any other extracurricular activities do NOT equal an excused absence. 2 unexcused absences from CHAMP will equal a removal from the program. Also, if I need to miss a Monday, I know who to contact. *
I acknowledge that it is required I choose 2 Mondays to ride the church vans home with the students, and I will need to be available until 6:15pm on those days. Also, I know where to sign up to help. *
I agree to present proof of vaccination or a weekly negative COVID19 test prior to entering the church building and/or Dilworth Elementary. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy