MENTOR LEADER PROGRAM APPLICATION
High School Students
Thursdays
6:30 PM – 8:30 PM
All interested applicants must provide a signed permission slip for consideration.
This document does not guarantee your child membership to the Program. Students must submit the application and 1-page personal essay to be considered. The SHINE Program will not provide transportation service, therefore we ask students to be picked up promptly at 8:30 PM.
If you have any questions, please call Luz Acosta at (928) 318-5801 or email LuzA@hacy.org.
Release Form
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I, the undersigned, hereby release The SHINE Program, its sponsors, and all associated personnel (managers, assistants, coaches, volunteers, etc.) of any liability that my child might incur while participating in The SHINE Program. It is further understood that my child will respect and follow program rules and codes of conduct. The SHINE Program, its sponsors, and all associate personnel reserve the right to photograph facilities, activities, and program participants for potential future use. All photos will remain the property of The SHINE Program and may be used for publicity.
 
Additionally, I understand that my child will participate in an Arizona Western College (AWC) accredited course and my child must comply with their respective policies, code of ethics, rules, and regulations. As an extended AWC site, the SHINE Boys and Girls Center reserve the right to suspend or terminate my child’s participation in the accredited course and all other activities associated with it.

Your Signature

Application
Preferred form of contact:
Can we send you text messages for reminders, updates, etc.?
Are you involved in any of the following?:
Are you employed?
Do you need community service hours?
If yes, for:
Are you currently enrolled at AWC?
Required
Please email a 1-page personal essay to Luz Acosta at LuzA@hacy.org.
Applications without an essay will not be considered. Please answer at least 3 of the following questions in your essay:
 
  • What are your strengths and weaknesses?
  • Who or what motivates you?
  • Do you believe leaders are born or made?
  • Do you consider yourself a leader? Why or why not?
  • How would you describe yourself?
  • What do you want people to know about you?
  • Has your character helped or hurt your success?
  • Would you change anything about yourself?
  • Why do you want to be a mentor?

Student's Signature

©2020 The SHINE Program, a division of the Arizona Housing Development Corporation (AHDC). All Rights Reserved.

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