Brown Girl Dreams Reality Consultant Application

Brown Girl Dreams Reality Consultant Application - Volunteers, Speakers, and/or Mentors

Brown Girl Dreams is a program for high school ladies that promotes self-empowerment, shifts their outlook on life, expands their mental capacity for success and reinforces the idea that it is acceptable to DREAM BIG! This application is for all those interested in serving as Reality Consultants - Volunteers, Speakers, and /or Mentors. We do ask that all of our speakers plan to deliver a very interactive presentation that will stimulate the minds of our Dream Girls. Please note immediately following the initial section, there are sections for those interested in serving as speakers and/or mentors. If those areas are of interest to you, please also complete the information in those sections as well.
Personal Information
Date

- Month - Day Year
Full Name

First Name Middle Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Number

- Area Code Phone Number
Mobile Number

- Area Code Phone Number
Work Number

- Area Code Phone Number
E-mail
Date of Birth

Month Day Year
Gender

Male Female
Please note the information requested below is for our background checks since you will be working within a school.
Social Security Number
Driver's License Number
Education & Training
High School Attended
Year of Graduation
College Attended (if applicable)
Degree
Year of Completion
Other Education, Certification, and/or Special Training:
Do you speak any language other than English? If so, please list:
Employment History
Employer
Position Held

Employer Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Supervisor's Name

First Name Last Name
Phone Number

- Area Code Phone Number
Application Questions
How did you hear about Brown Girl Dreams and why are you interested in being involved?
Are you interested in being a (check all that apply);

Volunteer Speaker Mentor
What qualities, skills, or other attributes do you feel you have that would benefit our Dream Girls?
Speaker's ONLY, Please Complete

Thank you for your interest in serving as a BGD Facilitator - Speaker for our 2013-2014 Brown Girl Dreams class! A BGD Facilitator is a dynamic speaker from the local and/or national community, who can translate a topic of choice in an interactive setting that captures the attention of our Dream Girls. We are excited about your interest to share your insight with our brightest, young minds about how to realize their dreams. We do ask that all of our speakers plan to deliver a very intereactive presentation that will stimulate the minds of our Dream Girls. Please select the topic you are interested in presenting and answer the questions below.
Topics:

Dream Boards-Discover Your Path Who Do You Want to Be?-Goals and Aspirations What's Cool About Me-What Do I Want to Be? Why? You-Nique!-Who Am I? Life Skills Being a Leader Responsibility/Priorities/Accountability Communication/Social Media Internet Safety/Posting Pics/Social Networking Community Service Getting Involved Service Project
Application Questions
Speaker Bio/Credentials:

0/300
Presentation Description:

0/250
Presentation Items (Videos, PowerPoint, etc):
Describe how your presentation will benefit the young ladies of Brown Girl Dreams:

0/150
Take-aways from the session (i.e. handouts, resources, to-do lists):
Is this an original presentation?

Yes No
List your audiovisual requirements for this session (if applicable):
Provide any existing web links to speaker videos online (if applicable):
Mentors ONLY, Please Complete:

Thank you for your interest in serving as a Reality Consultant - Mentor for our 2013-2014 Brown Girl Dreams class! A Reality Consultant is an extraordinary woman that serves as a BGD mentor who helps our Dreams Girls take their wildest aspiration and bring it to reality. We are excited about your interest to play a lead role in shaping the future for the next generation of young, female leaders. We do ask that all of our mentors plan to indulge in a two-way beneficial relationship with our Dream Girls and make this experience as enjoyable as possible for these young ladies. Please complete all of the following questions below.
Why do you want to become a mentor?
Do you have any previous experience volunteering or working with youth? If so, please specify.
Can you commit to participating as a mentor for a minimum of nine months?
Are you able to meet with your Dream Girl at least once per month?
Describe your general health. Are you currently under a physician's care or taking any medications? If so please explain.
Are you willing to communicate regularly and openly with program staff, provide monthly updates regarding your mentoring relationship/activities, and receive feedback regarding any difficulties during your participation in the mentoring program?

Yes No
Are you willing to attend an initial mentor training session and one in-service training session per year after being matched?

Yes No
Should be Empty:

Brown Girl Dreams Reality Consultant Application - Volunteers, Speakers, and/or Mentors

Personal Information

Please note the information requested below is for our background checks since you will be working within a school.

Education & Training

Employment History

Application Questions

Speaker's ONLY, Please Complete

Application Questions

Mentors ONLY, Please Complete: