MIND Mentor Application 2019
If you are interested in becoming a MIND Mentor for the 2019-2020 school year, please complete the questions below. Mentors should review the MIND Mentor Information (visit https://parkcityreads.org/mind/) and be in grades 8-12. Previous participation in MIND programs is required for students in grades 8 & 9.

If you have any questions, please email Lindsey at lindsey.aten03@gmail.com or Elissa at elissa.pcreads@gmail.com. Thank you!
Contact Information
Name (First, Last) *
Your answer
Email *
Your answer
Phone Number *
Your answer
Parent Name (First, Last) *
Your answer
Parent Email *
Your answer
Parent Phone Number *
Your answer
School Name *
Your answer
School Grade *
Your answer
MIND Activities
Which MIND programs have you attended? *
Required
Did you attend Dean Bragonier's presentation in October 2018? *
We have tentatively set the following dates for our MIND Events in 2019-2020. Please mark the events that you plan to attend. *
Required
Learning Differences
What is your learning difference? Check all that apply: *
Required
Do you have an IEP? *
Required
Do you have a 504 Plan? *
If you use Assistive Technology, check all that apply:
Interest & Training
Please explain why you would like to be a MIND Mentor (3-5 sentences). *
Your answer
MIND Mentors will have 2-3 training sessions during the year. Please mark all dates below that you could attend a training session in September. The purpose of this session will be to prepare for the first MIND Event, scheduled for September 15, 2019. *
Required
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