Thank you for your interest in the 2012-13 U of M History Day Mentor Program. Applications will be reviewed on an individual basis with varying criteria for what makes a good Mentor. Please include any experiences you've had that you think may be relevant to why you should be considered.

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* 1. Name:

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* 2. Year in school:

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* 3. U of M Student ID

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* 4. High School (include State/City)

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* 5. E-mail:

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* 6. Phone:

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* 7. Address:

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* 8. Major or focus of study:

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* 9. Are you familiar with the Minnesota History Day program?

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* 10. What is your knowledge or experience of/with the History Day program? Describe your history day projects (theme, topic, grade, school, level of achievement, etc.) and any experience you have as a history day student/volunteer.

NOTE: TO BE A MENTOR, YOU NEED NOT HAVE PARTICIPATED IN HISTORY DAY.

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* 11. How did you hear about this opportunity? (Referred by friend, flyer at school, MHS staff, etc)

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* 12. Do you have access to reliable transportation that will allow you to visit an area History Day school on a reliable basis? (car, bus, etc.)?

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* 13. Please complete the following skills inventory:

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* 14. Do you speak any language(s) other than English fluently? If you feel comfortable conversing with students in a language other than English, please indicate which language and your comfort level below:

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* 15. STATEMENT OF INTEREST

2.) Please describe why you are interested in becoming a History Day Mentor. What skills or experiences have prepared you for a position as a mentor? (150 - 250 words)

NOTE: Mentioning community/cultural experiences, clubs, research experience, relevant or related jobs, or experience working with junior high and high school students is encouraged.

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* 16. I certify that the facts set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, omission, misrepresentation, or concealment of information on this application may be sufficient grounds for disqualification from further consideration for hire or immediate discharge, and that National History Day in Minnesota Program shall not be liable in any respect if my scholarship/mentorship is so denied or terminated. I hereby assign to the National History Day in Minnesota Program all rights comprised in the copyright in all work produced by me within the scope of my scholarship/mentorship with the National History Day in Minnesota Program.

Thank you for your completion of the 2012 Mentor Application! Please double check that all answer have been completed and thoughtfully submitted.

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