2012 HYI Familia LEAD (formerly RA) Application Survey

The title of Resident Advisor (RA) has been changed to Familia LEAD. LEAD stands for Leadership, Empowerment, and Academic Development. We desire that the individuals who volunteer for this position understand that their purpose is to live out the acronym in the lives of the high school students that will be placed under their care at the HYI Kickoff.

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1. Personal Information

Personal Information First Name:
Last Name:
Gender:
Home/Permanent Address:
City/Town:
State:
ZIP:
Date of Birth:
Email Address:
Cell Phone #:

2. If your mailing address is different than your home/permanent address, please indicate below

If your mailing address is different than your home/permanent address, please indicate below Address:
City/Town:
State:
ZIP:

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3. Please indicate your shirt size

Please indicate your shirt size Small

Medium

Large

X-Large

XX-Large

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4. Please select the Hispanic Youth Institute Kick-Off Program where you were invited to participate

Please select the Hispanic Youth Institute Kick-Off Program where you were invited to participate Los Angeles HYI Kickoff

Silicon Valley HYI Kickoff

Greater Washington HYI Kickoff

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5. Currently I am a:

Currently I am a: Full-time College Sophomore

Full-time College Junior

Full-time College Senior

Full-time Professional

6. Please provide your expected Undergraduate Graduation Date

	MM		DD		YYYY
.	Please provide your expected Undergraduate Graduation Date . Month	/	Day	/	Year

7. College/University information

College/University information Name of college/university:
Your Major:

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8. Are you currently or have you been a Hispanic College Fund Scholar?

Are you currently or have you been a Hispanic College Fund Scholar? Yes	No
If so, please indicate what YEAR you received an HCF Scholarship?

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9. Have you completed an internship before?

Have you completed an internship before? Yes	No
If so, please indicate with which organization/company and the year you completed your internship

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10. Mentoring is a big responsibility and can change the lives of both the mentor and the mentee. Are you willing and able to commit yourself to year-round mentoring which will extend beyond the HYI Kickoff (e.g. attend year-round events, actively mentor students by engaging them in extracurricular activities as assigned by HYI Director, etc.)?

Mentoring is a big responsibility and can change the lives of both the mentor and the mentee. Are you willing and able to commit yourself to year-round mentoring which will extend beyond the HYI Kickoff (e.g. attend year-round events, actively mentor students by engaging them in extracurricular activities as assigned by HYI Director, etc.)? Yes

No

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2012 HYI Familia LEAD (formerly RA) Application
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