ROLE MODEL ENTRY FORM!

  • STEP 1 -- Complete all required fields in red. (Contact information is for SEMY use only and will not be published on the web.). We encourage you to complete each section
  • STEP 2 -- Add a picture to your entry. (Optional)
  • Click submit when complete. You will receive a confirmation email shortly after.


Personal Information
*  Indicates Required Field
Title: * Gender:
* First Name: * Last Name:
* Home Address: * City:
* State: * Zip:
* Home Phone: Home Email:
* Work Address: * City:
* State: * Zip:
* Work Phone: * Work Email:
* Birthplace:
Former Migrant: Age:
Former/Current CAMP Student:  
Interested in tutoring Migrant Students in School?

Note: For those interested in providing tutoring to students, SEMY will publish your contact information on the role model web site accessible to other educators and the public.
Please contact SEMY if you would not like your contact information published on the web. Phone: (509) 836-7500

Language/s: English    Spanish
Other:
Would you like to share your story with Washington’s migrant youth in a 2-3 minute video? If so, please type the URL below. Content should focus on overcoming barriers and/or highlighting career, academic, or civic achievements.
Video Link:
Career/Education
Education:  
 
SLP Student Participant SLP Curriculum Facilitator
GED HS Diploma
Technical Certificate Associate:
Baccalaureate Master
Doctorate   Other:
Job Title:
Career Field:
Tell Us About Your-self:
My present goals are:
My most significant personal, educational, civic and/or career accomplishments have been:
The most influential person in my life was/is _____ because _____:
The most significant barrier I had to overcome to achieve my goals was:
My friends would say:
My critics would say:
A significant inspirational quote I would like to share is:
If I were to do something differently in my life, what would it be:
 
Other Information
Interested in becoming a motivational speaker or event staff at a conference for migrant students?
  Yes | No
Interested in carrying on e-mail communications to inspire and guide secondary school age migrant students?
  Yes | No
Will the submitter share skills and/or talents with migrant students?
  Yes | No
Briefly describe ways in which you could support students through email.
 
May SEMY release Contact Information to educators?
  Yes | No
 
Enter Text Below:
 
 

  • Note:Information conveyed does not constitute Secondary Education for Migrant Youth’s (SEMY’s) recommendation for any individual whose photograph, contact information, or biographical data is conveyed. The information at www.semy.org might include opinions or views which are not necessarily those of SEMY or Sunnyside School District.

 
 

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