C.A.R.E. University Student Advocate

1

Please choose a location in which you would like to be an advocate for.* This field is required.

Elkhart

Indianaplolis

Northwest Indiana

2

Full Name* This field is required.

First Name

Last Name

3

Birthdate* This field is required.

Date

4

Phone Number* This field is required.

Area Code

Phone Number

5

Email* This field is required.

example@example.com

6

Mailing Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

7

Job Title* This field is required.

8

Best way to contact you?* This field is required.

Phone

Email

Text

9

How many students would you like to be matched with?

10

Do you have any felony convictions

YESNO

12

Are you willing to contact student(s) 5-6 times during the school year?

YESNO

13

Any areas of interest or hobbies?

14

Anything else we should know to help with matching you with a student?

15

Shirt Size* This field is required.

16

Are you willing to commit to a Student Advocate training session

YESNO

17

CONFIDENTIALITY NOTICE:

This message and any accompanying documents contain information belonging to the sender which may confidential and legally priviledged. This information is only for the use of the individual or entity to which it was intended.