The Special Education Dance 2012 Mentor Application

The Student Information page of this application (Page 2), the online application, Teacher Recommendations (Page 3), and a $15 non-refundable donation are due to Room 316 no later than 3:30pm on Wednesday, January 25 th .

Thank you for taking the first steps to make a difference in our community and the life of another student. This dance will leave you mentally and physically exhausted but with an adrenaline rush from knowing that you made a difference! The goal of The Special Education Dance is to make a positive impact on each and every one of our guests; The Dance will be a rewarding experience for you both. It is mandatory that you fulfill all of your responsibilities of being a mentor in every way that you can in order to make this dance a huge success. The theme of the dance is “Luau”. We will be giving out Luau themed shirts, which you will be required to wear on the day of the dance with a nice pair of jeans. Do not forget that the complete focus of this dance is our guests, so please remember to be an enthusiastic host, give 110% towards our guests, and to help clean up afterwards. On February 13th (day of the dance) you will miss part of 1st period, 2nd period, and a portion of 3rd period. Your teachers must approve of your absence for all three periods, and you must submit a completed field trip form. Before, during, and after the dance, there are responsibilities all mentors must carry out. Mentors are responsible for showing up to the mentor meeting, and assisting with the set-up AND clean-up of the event. Dates to Remember… January 25th – by 3:30pm- all mentor applications, teacher recommendations, field trip form plus $15 due to Rm. 316 January 31st at 7:45 am or February 2nd at 3:45- Attendance required for one of the two meetings th February 12 - 1pm- mandatory dance set-up (you will be assigned a duty to complete) February 13th - beginning of 1st period- dance begins

Your dedication and participation is crucial in making this event life-changing for our guests! Thank you!
The Special Education Dance 2012 Mentor Application- Student Information Sheet Name: _________________________________________ Grade: 9 10 11 12

First period Teacher: ____________________________ Room Number: _________ At home, or in the cafeteria, complete the online application at: https://docs.google.com/spreadsheet/viewform? hl=en_US&pli=1&formkey=dDRHVi1VT0VVaU9fOTR0OWRWSjd1WWc6MQ#g id=0 Below, please briefly tell us why you think you would be an asset to this event.

Class teachers’ approval: Students will miss first, second, and most of third period. 1st period ___________________________ approve / disapprove nd 2 period ___________________________ approve / disapprove 3rd period ___________________________ approve / disapprove th 4 period ___________________________ approve / disapprove
By signing below, I agree to… • Attend the mentor meeting one of the dates listed previously • Help with the Dance set-up and clean-up • Give 110% towards guests at dance • Wear mentor shirt, nice jeans and closed toe shoes at the dance Failure to comply with the above and normal school rules will forfeit your admittance to the Dance. Student Signature: _________________________________ Date:_______________

For Mane Link use only. How many days absent? ____ ____ OSS_____ ISS______ SS______ How many days tardy to class? ____ To school?

Each mentor is required to get 3 teacher recommendations, which must be handed in by the teacher to Rm. 316 by January 31st Teacher Recommendation: Please rate the student in the following categories, with 5 being the highest and 1 being the lowest. Please be completely honest! (Please turn in to Rm. 316 by January 31st ) Student Name: _________________________ Responsibility 5 4 3 2 1 Teacher Name: _________________________ Integrity 5 4 3 2 1 In your opinion is this student qualified to be a host at The Special Ed Dance Yes / No Additional Comments: ___________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Teacher Recommendation: Please rate the student in the following categories, with 5 being the highest and 1 being the lowest. Please be completely honest! (Please turn in to Rm. 316 by January 31st ) Student Name: _________________________ Responsibility 5 4 3 2 1 Teacher Name: _________________________ Integrity 5 4 3 2 1 In your opinion is this student qualified to be a host at The Special Ed Dance Yes / No Additional Comments: ___________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Teacher Recommendation: Please rate the student in the following categories, with 5 being the highest and 1 being the lowest. Please be completely honest! (Please turn in to Rm. 316 by January 31st ) Student Name: _________________________ Responsibility 5 4 3 2 1 Teacher Name: _________________________ Integrity 5 4 3 2 1 In your opinion is this student qualified to be a host at The Special Ed Dance Yes / No

Additional Comments: ___________________________________________________ _______________________________________________________________________ _______________________________________________________________________

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