Hometowns Chattanooga Mentors Civics Education / The Supreme Court and My Hometown / Hometowns Chattanooga Mentors Hometowns Student and College Mentors, please complete the following form. Thank you! Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1. Legal Name *FirstLast2. Preferred Name3. Permanent Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code6. Emergency Contact #1 *FirstLastPhone * be Do 9. Relationship *7. Emergency Contact #2 *FirstLastPhone *Relationship *9. Do you have any food allergies or restrictions? Please list below: *10. Do you have any medical concerns of which the program staff should be aware? *11. How will you commute to the program? *I will be driving an will need parkingI will be dropped offI will be using public transportationOther (please specify)Other (Question 11)12. When you arrive at the Courthouse, you will need to provide photo ID. Which of the following do you have? *Drivers LicensePhoto IDU.S. Passport or Passport CardI do not have a government issued photo ID13. I confirm that I am able to attend each day of the program and plan to be present for each FULL day (8:30-3:30) *YesNo16. I will be working with people who bring diverse personal experiences to this program. I will be respectful to anyone with whom I interact. *AgreeDisagree17. I will fully participate and be engaged in each session of the program. *AgreeDisagree19. A brief bio (100 words or less) that will help us get to know you better. *Other (Question 20)21. Fun Fact: We will be playing a get to know you game, so please provide a fun fact that will help your peers get to know you. *Make it FUN!!22. What is your favorite snack?23. Please upload a yearbook/headshot style photo of yourself. This picture may be shared in publications related to this program. * Drag & Drop Files, Choose Files to Upload 24. (Hometowns Alums ONLY) Please upload a signed copy of your permission slip. The paperwork can be printed, signed by your parent or guardian, and then either scanned and uploaded or take a photo and upload. * Drag & Drop Files, Choose Files to Upload 25. Everyone: Please upload a signed copy of your release form. The paperwork can be printed, signed by your parent or guardian (if under 18), and then either scanned and uploaded or take a photo and upload. * Drag & Drop Files, Choose Files to Upload Submit