Young Women in Science Mentor Application Form
For young women currently in grades 9 - 12
Applicant Information
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
Please use format: month/day/year (01/02/03)
Your answer
Street Address *
Your answer
Town, State *
Your answer
Zip Code *
Your answer
Home Phone #
Your answer
Cell Phone # *
Your answer
Email Address *
Your answer
Grade *
Current grade.
School *
Your answer
Name of Science Teacher Reference *
Your answer
Preferred Communication Method
Have you participated in a Flying Cloud Insititute program before? *
If yes, in which program(s)?
If no, how did you hear about this program? *
Required
Primary Parent/Guardian Contact Information
Full Name
Your answer
Phone #
Your answer
Email
Your answer
Secondary Parent/Guardian Contact Information
Full Name
Your answer
Phone #
Your answer
Email
Your answer
References
Please list at least two, non-family references include Name, Relationship, Contact Number, and Years Known
Reference 1.
Your answer
Reference 2.
Your answer
Applicant Questions
Please answer the following using 3-5 written sentences for each question
Please list any scheduling conflicts you are aware of (including weekends)
Your answer
Briefly tell us a little bit about your yourself and what makes you unique.
Your answer
Why do you want to be a mentor?
Your answer
How do you feel about Science/ Math?
Your answer
What are 3 qualities that you believe an effective mentor/leader should have and why?
Your answer
Commitment Form
Girls Science Club Senior Mentor Job Contract
By choosing to mentor for YWIS GIRLS Science Club, I agree to:
• Follow all rules and guidelines as outlined by the program coordinator, mentor training, program policies, and this contract

• Do my best to create a fun, and worthwhile experience for all of the GIRLS Science Club participants and contributors. 

• Be flexible and provide the necessary support and advice to help participants succeed

• Make at least biweekly contact with the program coordinator

• Be on time for scheduled meetings or call the program coordinator at least 24 hours prior if I am unable to make a meeting

• Inform the program coordinator of any difficulties or areas of concern that may arise during mentorship

• Participate in an end of program showcase 

• Notify program coordinator if I have changes in address, phone number, or employment conflicts with work schedules

• I will use my capabilities to learn and understand topics and have enthusiasm for STEM subjects

I agree to follow all the above stipulations of this program as well as any other conditions as instructed by the program coordinator at this time or in the future. *
Parent/ Guardian Permission Form PDF
I agree to print the Parent/Guardian Permission form PDF off of the FCI website, have it signed, and bring it to the first day of club. *
(If I don't have access to a printer, I will contact Flying Cloud immediately following my submission of this application)
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