Raising As We Rise Student Mentoring Organization

Raising As We Rise Student
Mentoring Organization
Raising as we Rise is a student
run mentoring organization that
takes Michigan State University
students and pairs them with
student in grades 7 12 in order
to develop a mentor mentee
relationship. The organizations
purpose is to assists young
adults who need assistance in
preparing for high school and
college to connect with someone
who attends a university that can
motivate and assist the child in
getting to his or her goal.
Program: Raising As We Rise Student Mentoring Organization

Dates Attending: October 2015- May 2016
Program Summary.
With our program, mentees will be brought to Michigan State Universitys campus in
order to participate in various activities with their assigned mentors. These activities
include, but are not limited to
Skill building exercises

Tutoring sessions
Community service events
College prep workshops
Writing workshops
Bonding exercises with mentors and other mentees in the program.
Listening to successful students leaders at Michigan State University
Company presentations
College advisor speaking to mentors and mentees
And many more activities.
The organization aims to assist in motivating students who need guidance toward
college and are having a difficult time in schools. We aim to bond with the youth of our
community in order to guide them to become leaders in the community in the future.
All mentors are Michigan State University students; either undergraduate or graduate.
Every mentor applicant is interviewed prior to the mentor meeting students and given a
background check. Each applicant must be able to commit to attending the vast majority
of mentor mentee events. We do not want any child to be left out or feel alone at any
event; we take mentor-mentee relationships very seriously.
All on campus events are free to Mentees. Snacks will be provided to students during
on campus events. Students will also be provided T-shirts
When an event is scheduled off campus, for instance a bowling or laser tag event for
mentor and mentee bonding, permissions slips with location, time and cost will be sent
home prior to the event date with the student.
At the end of the packet is the mentee profile that needs to be filled out by the student.
If you have any questions, please feel free to email us or call our president or vice
president directly
President: Breanna Oakley
Phone: 248.808.8785
oakleyb1@msu.edu
Rawrmentoring.weebly.com
Rawrmentor@gmail.com

Phone:312.771.0072
Vice President: Rhea Moore
moorerhe@msu.edu
Tentative On-Campus Activity

Dates:
Fall 2015
October 10, 2015
October 31, 2015
November 21, 2015
December 5, 2015
All events will take place on campus in the MSU Union Room 50, 49 Abbot Rd,
East Lansing, MI 48824. From 11am to 2pm
In January, the spring dates will be sent to parents and schools.
Transportation
If student needs transportation to and from Michigan State University, our program
is willing to provide pick-ups/drop-offs from the students High School/Middle School
or other agreed upon pickup/drop-off point. The students will be picked up/dropped
off in a university vehicle driven by a verified driver.
If your student will need transportation please select/highlight below
Yes, my student needs transportation
Parent Guardian Documents.

On the following pages, there are documents that need to be filled out and returned
either through email or with the child at the beginning of the program
Medical Treatment Authorization

Media Release
Parent Guardian Consent

MEDICAL TREATMENT
AUTHORIZATION FOR MICHIGAN
STATE UNIVERSITY
Your child will be involved in a Michigan State University program on the above date(s). This form must be
completed and signed by a parent or guardian to give a medical facility permission to treat the participant
for minor injuries or medical problems. In the event of serious injury or illness, the parent or person
designated will be contacted. Treatment will proceed before contacting the parent or person designated
only if the situation is urgent and does not permit delay.
Participant's full legal name:
Birth date:
Mailing Address:
Parent phone:
Day:
Evening:
Primary care physician's name:
Physicians phone:
Sex:
Physician's address
HEALTH INSURANCE INFORMATION:

Policy holder's name and relationship to participant:
Policy holder's address
Please attach a photocopy of both sides of your insurance card OR complete the information requested
below.
Insurance company phone number:
Insurance company name and address:
All policy numbers (please identify):
If you have HMO insurance, please list the emergency treatment authorization phone number:
Business phone
Employer's name and address

INFORMATION NEEDED ABOUT PARTICIPANT:

Please put yes or no. If yes, explain below or on another sheet if you need more room.
YES NO
Does the participant have any chronic health problem or illness?
Does he or she have any acute illness now?
Has the person been treated recently for some medical problem?
Does he or she have any allergies?
Does he or she have any allergies to medication or local anesthetics?
Date of his or her last tetanus shot:
List any medications he or she is now taking for treatment of any medical problem.
OFFICIAL AUTHORIZATION FOLLOWS:

I (parent or legal guardian), ____________________________________, recognize that while attending
this program, medical treatment on an emergency basis may be necessary for my child, and I further
recognize that the program director may be unable to contact me for my consent for emergency medical
care. I do hereby consent in advance to such emergency care, including hospital care, as may be
deemed necessary under the circumstances and to assume the expenses of such care. I also authorize
the medical facility to release any and all information required to complete insurance claims and also
authorize insurance payment directly to the medical facility.
Signature of Parent/Guardian or of participant aged 18 and up:
Date:

MICHIGAN STATE UNIVERSITY

MEDIA RELEASE FORM
Participants in MSU sponsored programs and activities may be photographed and
videotaped for use in MSU promotional and educational materials. The participants are
not identified by name in the materials.
I authorize MSU to record the image and voice of the subject named below and I give
MSU, and all those acting with MSUs approval, all rights to use these images and voice
recordings. I understand that such images and/or recordings may be used for
educational and promotional purposes. This authority extends to all conventional and
electronic media, including the Internet and any future media, and to any printed
material.
I understand and agree that these images and recordings may be duplicated, distributed
with or without charge, and/or altered in any manner without compensation or liability, in
perpetuity.
Print subjects name:
Signature of Parent/Guardian of minor participant or of participant aged 18 and up:
______________________________________________ Date: ____________
______________________________________________ Date: _____________
Parent Email:

MICHIGAN STATE UNIVERSITY

YOUTH PROGRAM
PARENT/GUARDIAN CONSENT
FORM
I grant permission for (print participants name) _____________________________ to
participate in all educational and social activities of the following MSU program or
activity:
Program name: Raising As We Rise Student Mentoring Organization
Program dates: October 2014 May 2015
MSU unit/department: Student Life: Registered Student Organization
I understand that sessions may entail field trips and/or campus facility tours. I also
understand that participants may engage in athletic or other recreational activities that
have special risks. I have read the session descriptions and approve of my childs
selections. I accept any risks associated with the assigned sessions and selected
recreational activities. I understand that my child has a role to play as regards his or her
safety and security. I will speak with my child about the need to honor safety rules and
to behave responsibly.
(Please print):
________________________________________________________________
(Parent or legal guardian)
Signature:
__________________________________ Date: _________________
Parent or Legal Guardian Email:

Student Profile
Student Information
Name
Cell Phone Number
School
Academic Counselor
Grade
Personal E-Mail Address
Allergies:
Gender
Hobbies
What do you like to do for fun? Please circle
Hang with friends
Watch TV
Read
Watch Movies
Play Video Games
Go to the Mall
Go Skating
Play Sports
Other________________________________________________________________________
Things Want to Improve

Tell us which areas you are interested in improving academically
Math
English
Social Studies
Science
__________________________Other
Interests
Summarize any interests that you have that you would like to learn about from the program and your
mentor .

Raising As We Rise Student Mentoring Organization

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Raising As We Rise Student Mentoring Organization

Uploaded by

Copyright:

Available Formats

Raising As We Rise Student

Program: Raising As We Rise Student Mentoring Organization

Skill building exercises

Program: Raising As We Rise Student Mentoring Organization

Tentative On-Campus Activity

Parent Guardian Documents.

Medical Treatment Authorization

Program: Raising As We Rise Student Mentoring Organization

HEALTH INSURANCE INFORMATION:

Program: Raising As We Rise Student Mentoring Organization

INFORMATION NEEDED ABOUT PARTICIPANT:

OFFICIAL AUTHORIZATION FOLLOWS:

Signature of Parent/Guardian or of participant aged 18 and up:

Program: Raising As We Rise Student Mentoring Organization

MICHIGAN STATE UNIVERSITY

__________________________________ Date: _

Program: Raising As We Rise Student Mentoring Organization

MICHIGAN STATE UNIVERSITY

Program: Raising As We Rise Student Mentoring Organization

Play Video Games

Things Want to Improve

You might also like