Grounding Waters Participant Sign Up

Grounding Waters Mentoring Program

The Grounding Waters Mentoring Program is an opportunity for you to learn about environmental issues in the Portland Metro area, while being mentored by Black environmental science college students and professionals. The hands-on learning experiences are not only fun, but can lead to internships and school credit. This opportunity represents a $9,395 per student investment. Complete this contract to sign up for the program.

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* 1. Contact Information

Name

Grade Level

Age

E-Mail Address

Home Address

Your Phone #

Your Guardian/Parent's Phone #

Food allergies or restrictions (list all)?

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* 2. What is your gender?

Female

Male

Non-gender conforming

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* 3. Please describe your race/ethnicity.

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* 4. Which of the following fields align with your career interests or hobbies? check all that apply

Green Building

Environmental Science

Fisheries and Wildlife/Biology

Natural Resources

Civil Engineering

Construction/Trades (e.g., carpentry, electrician, masonry, HVAC, etc.)

Landscape Architecture

Water Resources

Urban Forestry

Ecology

Social Justice

Environmental Justice

None of these

Other (please specify)

Grounding Waters involves a high level of commitment and consistent effort. In order for this program to be successful we have established a list of expectations for you as a mentee. Please read each and agree to each:

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* 5. I will represent myself, my school, and my community in a positive manner

I agree

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* 6. I will schedule one-on-one meetings with my mentor at least three times a month (with at least once a month being in person)

I agree

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* 7. I will maintain confidentiality (refrain from gossip about your peers to others)

I agree

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* 8. I will respond in a timely manner to all communication from my mentor and the Grounding Waters program coordinator

I agree

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* 9. I will attend the scheduled activities and take an active role in team projects

I agree

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* 10. I will attend the Mentoring Program Closing Dinner, where the technology will be awarded

I agree

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* 11. I will honor the one academic year time commitment

I agree

SIGNATURE BLOCK

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* 12. By signing this contract I agree to participate in the Grounding Waters Mentoring program for the 2017-2018 academic year and to adhere to all of the expectations listed in this contract.

Yes, I understand

Thank you for your interest in being a Grounding Waters student. If you have any questions, please contact Jason Stroman: EMAIL: jason@theblueprintfoundation.org PH: (503) 901-6845.