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!  

* 1. First Name:

* 2. Last Name:

* 3. Male/Female

* 4. Date of Birth:

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

* 6. Marital Status:

* 7. Children:

* 8. Home Address

* 9. Work Address:

* 10. Contact Details:

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

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

* 13. Which type of student do you prefer?

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

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

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

Please contact Curt Dircks by phone at 973-819-6071 or email curt.dircks@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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