2020 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 November 30, 2020. Program will be facilitated through the IAM Mentoring mobile app, allowing students to complete program sessions at their own pace until the end of May. All applicants and their parents will be notified via email prior to that date about their participation in the program.

- Mandatory parent orientation will be Wednesday, December 2nd at 8PM
- Mandatory student only orientation & virtual Holiday celebration will be Wednesday, December 16th at 6PM
- First Official Day of Program: Wednesday, January 6 at 6PM

Accepted students must pay a one-time registration fee of $50. The balance must be paid in full before students can start 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 *
Student Last Name *
Student Phone Number *
Student Email Address *
Grade *
School currently attending *
Mailing Address *
Street portion only. Example: 30 S. 15th Street
City *
Please write out full names. Example: Philadelphia
State *
Use initial. Example: PA
Zip Code *
Parent/Guardian Name *
Who should be copied on emails about the program?
Parent/Guardian Email Address *
Who should be copied on emails about the program?
Parent/Guardian Phone Number *
We will call your guardian to discuss the program application and seek approval for your participation.
Sessions this year will be held on Zoom. Do you have reliable internet access and a computer with camera? *
Engagement between Zoom sessions will take place on the IAM Mentoring Mobile app. Does student have a cell phone or access to use a cell phone on a daily basis AND be able to download and use the IAM Mentoring mobile app (available for iPhones, Androids and on tablets). *
Sessions are held on Wednesdays from 6:00PM - 8:30PM, will being on time and staying online for the entire session be a challenge? (A 30 minute Break will be given during each session from 7PM - 7:30PM) *
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