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Role Model

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Role Models

"If I can do it, so can you!"

Submit your Role Model

Help become an inspiration to our migrant youth. Registering is quick and easy just follow the three simple steps below.

Note: Personal contact information is for SEMY use only and will not be displayed on the Web.

Step-1

Step-2

Step-3

Personal Information

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:

Mexico Cuba

Central America Puerto Rico

South America Canada

USA

Other:

Former Migrant Student/Worker: Yes | No

Age

Languages Spoken: English
Spanish
Other

Education

Education:

SLP Student Participant SLP staff

GED HS Diploma

Technical Certificate Associate:

Baccalaureate Master

Doctorate

Other:

Position 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

Email address

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

Date of entry:

Entered by staff member:

Phone Number (for verification purposes only)