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TEACHERS

Role Model volunteers conduct a minimum of six, 1-hour "Dare to Dream©" visits and two follow-up 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.

Important: You must submit a separate/new request for follow-on classes even if you would like to have the same Role Model Volunteer conduct the program for your next class. This process helps coordinate all aspects of the program.

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:
Additional Offerings
Are you interested in one of the following additional presentations? Please click YES or NO for each item. The Role Model Program will act as liaison between you and your selected programs. Please note that you will be required to work with us and/or the partnering group for scheduling and implementation.
"Dream to Do It" (Write yes or no)
This workshop focuses on community building and goal setting presented by members of the Youth Task Force of Santa Clara County. This workshop is limited to 25 classrooms over the course of the school year. Workshops will be scheduled on a first-come, first-served basis.
"Gang Awareness and the Consequences of the Choices We Make" (Write yes or no)
This session is an interactive presentation given by members of the STAND Program and Right Connection. This workshop is limited to 7th and 8th grade classrooms in the Alum Rock School District, Franklin McKinley School District, Burnett Academy, Willow Glen Middle School, Martin Murphy Middle School, and McKinnon Middle School. A maximum of 25 presentations will be given and will be scheduled on a first-come, first-served basis.
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.