The High School for Leadership and Public Service needs you!   

Take the first step in becoming a mentor in SUMMA (Syracuse University Mentor/Mentee Alliance). Please complete this form so we have all of your information. 

Thank you!  
First Name:

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* 1. First Name:

Last Name:

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* 2. Last Name:

Male/Female

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* 3. Male/Female

Date of Birth:

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* 4. Date of Birth:

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SU College Information (or other if not SU):

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* 5. SU College Information (or other if not SU):

Marital Status:

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* 6. Marital Status:

Children:

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* 7. Children:

Home Address

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* 8. Home Address

Work Address:

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* 9. Work Address:

Contact Details:

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* 10. Contact Details:

What is the nature of your current job or career?

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* 11. What is the nature of your current job or career?

What are your special interests, hobbies or skills outside of work?

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* 12. What are your special interests, hobbies or skills outside of work?

Which type of student do you prefer?

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* 13. Which type of student do you prefer?

Best time to meet with your student (click all that apply):

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* 14. Best time to meet with your student (click all that apply):

Are you required to travel for extended period of times because of work?

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* 15. Are you required to travel for extended period of times because of work?

If you have any comments, concerns or questions, please enter them here:

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* 16. If you have any comments, concerns or questions, please enter them here:

Please contact Megan Hickey by email hickey.megan@gmail.com if you have any questions about this registration form -- and thank you again for your interest in becoming a mentor with SUMMA!

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