Applicant's Name *

First Name

Last Name

Applicant's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Applicant's Primary Phone Number

(###)

###

####

Applicant's Date of Birth MM/DD/YYYY *

MM

DD

YYYY

Parent/Guardian's Name

First Name

Last Name

Parent/Guardian's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian's Primary Phone Number

(###)

###

####

Eligibility *

The applicant must meet at least one or more of the listed criteria below to be considered for the scholarship program. Check all that apply.

I am a Minnesota resident

I live in a low-income household

My family receives government assistance

I attend public or alternative school or my family has limited resources

My family cannot afford exercise or health services

Gender Identity

How do you identify?

Female

Male

Transgender

Other

Race/Ethnicity

Please select all that apply.

American Indian or Alaskan Native

Asian/Pacific Islander

Black

Hispanic or Latino

White/Caucasian

Would rather not answer

School Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

School Primary Phone Number

(###)

###

####

Check the box if you understand. *

By checking this box, I confirm that all of the information provided in this application is true and correct to the best of my knowledge.

Full Name

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent's Phone

(###)

###

####

Student's Phone

(###)

###

####

Date

MM

DD

YYYY

As a student, I agree to participate in Rising Sons. *

Yes, I agree to participate in the Rising Sons Mentorship program.

As a parent/guardian, I agree to allow my son permission to participate in Rising Sons. *

Yes, I agree to allow my son permission to participate in Rising Sons Mentorship.

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Availability

During which hours are you most often available for mentorship participation/duties?

Weekday mornings

Weekday afternoons

Weekday evenings

Weekend mornings

Weekend afternoons

Weekend evenings

Do you own or have immediate access to a vehicle?

Yes

No

Name of Person to Notify in Case of Emergency

First Name

Last Name

Emergency Contact Street Address, City, State, Zip Code

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Home Phone

(###)

###

####

Emergency Contact Work Phone

(###)

###

####

Date

MM

DD

YYYY

Agreement *

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a mentor or volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Yes, I affirm that the facts set forth are true and complete.

Which volunteer or mentorship opportunities interest you? *

Mentor for the new Rising Sons program

Volunteer with CO·MOTION marketing

Volunteer for CO·MOTION fundraising

Volunteer for CO·MOTION event coordination