Power Lunch Academic Mentor Application Volunteer Commitment Commitment AgreementI acknowledge this is a one-hour weekly commitment at least once a week for the duration of the school year Virtual/Online Mentoring RequirementsI have regular access to a device with a high speed internet connection, a video camera and microphone to participate in an online interview, online training, and online volunteer opportunity. Contact Information SalutationPlease select... Mr. Ms. Mrs. Mx. Dr. Lt. Supt. Rev. First Name Last Name SuffixPlease select... MD Sr. Jr. I II III IV Esq. Ph.D. Email Confirm Email Street Address and Unit Number City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau ZIP Home Phone Cell Phone If you do not have a cell phone, please input your preferred number here. Work Phone Emergency Contact Name Emergency Contact Relationship Emergency Contact Phone Background Date of Birth MonthPlease select... 1 2 3 4 5 6 7 8 9 10 11 12 DayPlease select... 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YearPlease select... 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 GenderPlease select... Female Male Non-binary Race or Ethnicity you most identify with:Please select... Non-Hispanic White or Euro-American Black, Afro-Caribbean, or African American Latino or Hispanic American East Asian or Asian American South Asian or Indian American Middle Eastern or Arab American Native American or Alaska Native Other Prefer Not to Answer Parent or Guardian of BPS Student?YesNo At which school(s)? Did you attend a BPS school?YesNo Which school(s)? Based on your personal and professional skill set, please select any other ways you would be interested in supporting Boston Partners in EducationNot ApplicableMarketingFundraisingVolunteer RecruitmentTechnical SkillsOther Please provide any relevant details EmployerPlease select... Abt Associates American Student Assistance Brown Brothers, Harriman & Company Holland & Knight LLP JP Morgan Chase Kaestle Boos Associates, Inc KPMG Ropes & Gray LLP Westfield Capital Management Job Title If you already have a partner for your match planned, please enter their name below. Do you speak any languages other than English?NoneCape Verdean CreoleChineseHaitian CreolePortugueseSomaliSpanishVietnameseOther Please Specify Do you have a physical condition that should be considered in selecting the right school assignment for you?YesNo Please Describe Volunteering Goals In what ways do you anticipate being able to help students both academically and socially? Contact Information
