Dear Student Leader Applicant,
Thank you for your continuing interest in the STEP-UP Boys Mentorship Program Summer Summit for 8 th grade men. We are excited at the prospect of having you return this summer to serve as a leader and role model for this year’s participants. The work of a student leader is important and each student leader must be able to do the following:
1.
Show initiative by getting involved with the group; do not wait to be asked.
2.
Demonstrate good communication by relating your thoughts and words in a positive manner.
3.
Become engaged in all planned activities for the week.
4.
Be a positive role mode for the new Summer Summit participants.
To be considered as a student leader, you will need to complete the attached application form and submit it to your school’s designee along with the items listed on page two. The second part of the process will include a short personal interview with a representative from your current school. If you are selected as a student leader, you will be required to attend leadership training and all five days of the Summer Summit.
(Each district needs to identify their time line and contact person for this section.)
Monday, June 10, 2013, 8:30 a.m. – 12:30 p.m.
Location: Northwest Suburban Integration School District offices
6860 Shingle Creek Drive – Suite #208, Brooklyn Center
Monday, June 17 – Friday, June 21, 2013, 8:30 a.m. – 3:00 p.m. (does not include bus pick-up and drop-off times)
* If you have any questions, please contact: _________________________________________
Deadline to register is Friday, May 24.
6860 Shingle Creek Parkway, Suite 208 Brooklyn Center, MN 55430
Phone 763-450-1300 Fax 763-450-1348 www.nws.k12.mn.us

Please type or print neatly in ink:
Student’s full, legal name (include middle name): _________________________________________________________
Student’s address:______________________________________________________________ Gender: ____________
City, State: ________________________________________ Zip: _______ Birth Date: _____________ Age: ______
E-mail (for school communications): ___________________________________________________________________
School attended in 2012-13 school year: ________________________________ School District: ___________________
Parent/Guardian information (as applicable)
Name:
Mother Father
Home Address:
Home Phone: ( )
Work Phone:
Cell Phone:
( )
( )
( )
( )
( )
Guardian 1
( )
( )
( )
Guardian 2
( )
( )
( )
What is your definition of a student leader?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
___________________________________________________
Based on your experience at last year’s Summit, what could you offer the new summer participants?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
___________________________________________________
The above two paragraphs are to be completed in handwriting by the student or processed and attached to the application.
Student signature (MUST be signed): ___________________________________________________________
Parent signature (MUST be signed): ____________________________________________________________
6860 Shingle Creek Parkway, Suite 208 Brooklyn Center, MN 55430
Phone 763-450-1300 Fax 763-450-1348 www.nws.k12.mn.us

Please use the following checklist to ensure your application for the STEP-UP Boys Mentorship Program
Summer Summit Student Leadership position is complete.
Application Checklist: o Application o Two teacher recommendations o Progress report on grades o Attendance report for 2012-13 school year o Student Leadership applicants will complete an interview with a school representative
To prepare student leaders for their role, a mandatory Student Leadership training session will be held on
Monday, June 10, 2013 at Northwest Suburban Integration School District, 6860 Shingle Creek Parkway,
Suite 208, Brooklyn Center.
The 2013 STEP-UP Boys Mentorship Program Summer Summit will be held June 17 – 21, 2013. Student leaders will be expected to be in attendance all five (5) days. Student leaders will travel with the STEP-UP participants and STEP-UP Group Leaders on buses provided by their respective school districts.
DEADLINE TO REGISTER IS FRIDAY, MAY 24, 2013
6860 Shingle Creek Parkway, Suite 208 Brooklyn Center, MN 55430
Phone 763-450-1300 Fax 763-450-1348 www.nws.k12.mn.us