Roses in Concrete Waltham High School Student Application Form

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We are thrilled that you are interested in the Roses in Concrete Program. This application will be confidentially shared with the members of the planning and selection committees. Please know your responses will not be tracked and only used for matching purposes if you are selected for this opportunity.
It is important to note that there is an expectations that all Waltham High School participants must attend all 4 workshops, meet monthly with your Brandeis mentee.

Full Name *

Preferred Name or Nickname *

Full Email *

Class Year *

Gender Pronouns

Race/Ethnicity

Languages Spoken (fluently)

Please take a moment to tell us about yourself (favorite classes, career interest, extra-curricular clubs, etc.) *

If selected, this information will help us pair you with a Brandeis mentor this spring. Your response may be shared directly with them upon being matched.

Please share why you are interested in participating in this program. *

Please share 3 words that describe a mentor in your life and elaborate on why those attributes are important to you. *

Please share any additional thoughts that may be relevant to your application and our mentor-mentee matching process. *

Please check the boxes below acknowledging your commitment to this program if selected. *

I am available to participate in all workshops scheduled on the four Thursdays throughout the spring: Jan 20, Feb 3, Feb 17, and March 17 (6-7:30PM) .

I am available to meet with my mentor at least once a month during the spring semester.

I have shared that I am submitting this application with my parent, caregiver or legal gardian and have permission to participate.

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