Hutchinson Office

17 South Main Street Hutchinson, KS 67501 Voice: (620) 663-3989 Video: (620) 860-0140 Fax: (620) 860-0140 Toll Free:(620) 860-0140

Pratt Office

103 West Second Street Pratt, KS 67124 Voice: (620) 672-9600 Fax:(620) 672-9600

Dodge City Office

207 West Spruce St, Dodge City, KS 67801 Voice: (620) 371-7690 Fax: (620) 371-7689

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About
Blog
Contact Us
Gallery
Learn
Services
Success Stories
Support PILR
- Donations
- Events
  - ADA Celebration

Mentee Application

Home/Mentee Application

Mentee Application wpadmin 2016-12-07T18:29:42-06:00

Step 1 of 3

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Personal Information
Name*
First Last
Gender*
- Male
- Female
Date of Birth*
Date Format: MM slash DD slash YYYY
Address*
Street Address City ZIP / Postal Code
Phone
Email*
Education Information
Current Education Level*
Name of School*

Employment Experience
(or other volunteer activities, hobbies, etc.)
Employment Experience*
Career Interests
List three careers you might be interested in after high school. Please list a different career in each box. Please be aware that if you list the same career in every box the steering committee may be unable to place you or have to place you in a field that has no interest for you. If you are unsure of the career you are interested in pursuing, please look at the career clusters below and check the boxes of the career area that interests you.
Career Choice*
Career Choice*
Career Choice*
What is one thing you would like your mentor to know about you?
The steering committee will make every effort to place you with a mentor in a career you have listed. Please make sure that the careers you list are different from each other.
Career Clusters*
- Arts and Communication: Do you like to communicate ideas? Do you like to share information? Are you creative, imaginative and innovative? Do you like to express yourself in writing or with audio, visual or graphic media arts? Do you like to perform? Could you imagine yourself working at a museum or in other settings that promote and celebrate artistic expression?
- Business and Marketing: Are you organized, accurate and self-motivated? Are you a leader? Do you enjoy organizing people and planning events? Do you like computers and business machines? Do you like creating reports? Do you like marketing things? Do you enjoy working with numbers?
- Education: Would you enjoy teaching either children or adults in an academic setting?
- Food, Recreation and Hospitality: Do you enjoy the preparation of and/or serving of food either in a cafeteria or restaurant setting? Do you like organizing recreational activities such as social outings, competitive sports, arts and crafts, and picnics? Do you like putting together the logistics for conferences and conventions, community service projects, or other endeavors surrounding community relations? Do you enjoy being around people and picture frequent interaction with others as a vital part of your ideal work environment?
- Health and Medicine: Do you like to work with people? Are you interested in wellness and nutrition? Are you interested in working as a doctor, nurse, nurse practitioner, or medical assistant? Do you like new technology? Are you interested in medical research and figuring out the causes of diseases? Can you stay calm in an emergency?
- Human Services: Are you able to get along with a diverse group of people? Do you like serving the public? Do you have leadership ability? Are you patient and polite, yet able to make decisions? Are you dependable and hardworking?
- Law, Government and Public Policy: Do you like to follow current events? Do you like to learn about local, state, national, or international politics? Are you interested in how laws are enacted? Do you aspire to hold elected or appointed political office? Do you like speech and debate? Do you see yourself arguing a case in court? Do you like conducting research on the law, its practical application, and how it is interpreted? Do you envision helping to draft major public policy on issues you care about?
- Law Enforcement: Do you want to work as a police officer, sheriff, marshal, detective, or criminologist? Would you be interested in investigating and solving crimes?
- Natural Resources, Environment and Agriculture: Do you like the environment? Do you like working with plants and animals? Are you interested in physical resources such as land, water, soil, and weather? Do you like to observe, learn, investigate and solve problems?
- Technology, Engineering and Science: Do you enjoy math, technology, or science? Do you have the ability to be accurate, analyze data, and solve problems? Do you like designing things or drawing detailed plans? Do you like using machines and heavy equipment?
- Other: Do you fall into a category not directly covered above? If so, state your preference in the career interest area above.
Many students are unsure what career they want to pursue after high school. Sometimes it is important to look at a certain career instead of a specific job. below you will find a list of career areas and some explanation of the types of jobs you might have if you worked in those fields. Please check the boxes of any career area you might be interested in learning about during Disability mentoring day.

Other Information
Will you need any accommodations to participate in DMD such as alternative format? (Braille, Large Print, Sign Language Interpreters, etc.)
Please specify your accommodations
Will a para be accompanying you?
- Yes
- No
Dietary Restrictions
T-Shirt size*
School or Professional Contact
(Teacher, Professor, Counselor, Service Provider)
Contact Name*
Contact Title
Contact Telephone
Contact E-mail*
Contact Address*
Email
This field is for validation purposes and should be left unchanged.

Pratt Office

214 S. Main Street
Pratt, KS 67124

Voice: (620) 672-9600

Fax: (620) 672-9601

Dodge City Office

207 West Spruce St,
Dodge City, KS 67801
Voice: (620) 371-7690
Fax: (620) 371-7689

Newton Office

120 West 6th, Suite 140
Newton, KS 67114
By Appointment Only
Voice: (620) 663-3989

Copyright 2015 Prairie Independent Living Resource Center, Inc. | 17 South Main Street, Hutchinson, KS 67501 | (620) 663-3989