TEACHERS

Role Model Volunteers conduct six, 1-hour "Dare to Dream©" visits. One Role Model will be matched with each classroom request. If you are requesting multiple classes, please submit a separate Classroom Application for each request.

Fill out the web form below and click the "Submit" button at the end to forward your application.

Questions? Please call (408) 246-0433 or email: info@therolemodelprogram.org

* Indicates required fields

Applicant/Teacher Information
* First Name:
* Last Name:
* Full School Name:
* Street Address:
*City:
*State:
*Zip:
* School District:
* Email:
* Phone:
How did you hear about The Role Model Program?:
Applicant/Teacher Information
* Class Grade:
Preferred months, days, and times for visits:
Class Profile: Please list the number of students in each category. This information is required for funding purposes. Please do not use percentages.
* Total number of Students:
Gender:
* Female:
* Male:
Ethnicity:
* African American:
* American Indian:
* Asian/Pacific Islander:
* Caucasian:
* Hispanic:
* Other:
Is this a special needs, alternative or ESL class? If yes, please specify:
Reading Level:
Role Model Profile
"My students will benefit from a Role Model with the following characteristic(s): gender, profession, ethnicity and/or background." We use this information as a base for classroom matching. Please be as specific as you can so we can give you the best possible Role Model. (Note: In the "Other" category, enter the person's name to request a specific Role Model Volunteer.)
Background Preference:
Other:
Next Steps
1. Only completed applications will be processed. 2. The Role Model Program will review your application and match an appropriate Role Model Volunteer to your classroom. 3. The Role Model Program will mail the volunteer's name and phone number to you. 4. Contact your volunteer immediately and schedule your preliminary meeting. 5. If you feel that your Role Model is not a good match, notify us immediately and we will re-match your class.