Hometowns Minneapolis Mentors | Supreme Court Historical Society

1. Legal Name

First

Last

2. Preferred Name

3. Permanent Address

Address Line 1

Address Line 2

City

State

Zip Code

4. High School

5. Emergency Contact #1

First

Last

Phone

Relationship

6. Do you have any food allergies/restrictions or medical concerns? Please list below:

7. How will you commute to the program?

I will be driving an will need parking
I will be dropped off
I will be using public transportation
Other (please specify)

Other (Question 11)

8. When you arrive at the Courthouse, you will need to provide photo ID. Which of the following do you have?

Drivers License
Photo ID
U.S. Passport or Passport Card
I do not have a government issued photo ID

9. 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)

Yes
No

10. I will be working with people who bring diverse personal experiences to this program. I will be respectful to anyone with whom I interact.

Agree
Disagree

(if the yearbook/headshot

11. I will fully participate and be engaged in each session of the program.

Agree
Disagree

12. A brief bio (100 words or less) that will help us get to know you better.

13. Fun Fact: You will be included in our get to know you BINGO game – please provide a fun fact for us to share!

Make it FUN!!

14. What is your favorite snack?

15. 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

16. Everyone: Please upload a signed copy of your audio/video 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