MENTORS 4 COLLEGE STUDENT DATA FORM INFORMATION ABOUT YOU Question Title * 1. Student FIRST name Question Title * 2. Student LAST name Question Title * 3. Student telephone contact information (Please enter ONLY the student's cell phone number, not a parent cell phone) Student home phone (land line) number Student cell phone number Question Title * 4. Student email contact information (Please enter ONLY the student's email, not a parent email): Student PRIMARY email address (DO NOT use your school district email address! Some districts block our emails since we're outside the district.) Student ALTERNATE email address (if you have more than one) Question Title * 5. What's the best way to get in touch with student? Call my home phone Call my cell phone Text to my cell phone Email my parents Call my parent's cell phone Text to my parent's cell phone Question Title * 6. What High School does student attend? Affton Bayless Francis Howell High Francis Howell Central Francis Howell North Francis Howell Union Kirkwood Lindbergh Parkway Central Parkway North Parkway South Parkway West Rockwood Lafayette Rockwood Marquette Wentzville Holt Wentzville Liberty Wentzville Timberland Other (please specify) Question Title * 7. Year student will graduate High School 2021 2022 2023 2024 2025 2026 2027 Question Title * 8. What pronouns does student prefer to use? they/them/theirs she/her/hers he/him/his zie/hir/hirs ze/zir/zirs Other (please specify) Question Title * 9. Student's nationality/race White Black/African American Latino/Hispanic Asian Indian Other (please specify) Question Title * 10. How did your family first hear about Mentors 4 College? One of my siblings was in the Mentors 4 College program Counselor/Teacher at school Student friend Parent Friend I'm part of EST in California (Educating Students Together) Twitter Instagram Facebook page Mentors 4 College web site Mentors 4 College lecture or webinar School evening program (college night, curriculum night, back-to-school night) Other (please specify) Question Title * 11. If student has a sibling who was mentored through the Mentors 4 College program, please tell us this sibling's name Question Title * 12. Is today's date after April 1 of student's junior year (answer "Yes" if you're a senior or rising senior)? Yes No Question Title * 13. What country does student live in? Outside the United States In the United States (Please tell us student's Zip Code) 17% of survey complete. Next
