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
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Full Name
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
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Monaco
Mongolia
Montenegro
Montserrat
Morocco
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Myanmar
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Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
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Home Number
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Phone Number
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Work Number
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Area Code
Phone Number
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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
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
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
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