2017 Catalyst for Positive Change Student Profile Form

Please submit your profile using the form below as soon as possible but no later than Thursday, March, 2, 2017. In addition to this profile we will include your photo in the program for the CFPC event on Friday, May, 5, 2017. You will be able to upload your photo at the bottom of this form. Use your last name, first name as the file name.

If you have questions or concerns contact Kimberly Reynolds at Syntero's Dublin office.
EMAIL: kreynolds@syntero.org
PHONE: 614.457.7876 ext.237

NOTE: Fully completed student profiles must be submitted no later than midnight, March 2, 2017 in order to be considered.

STUDENT'S PERSONAL INFORMATION

In order that your name be read properly during the introduction it is important that we know the correct pronunciation. If your name is pronounced in a special way, please use the following pronunciation instructions to advise us how your name should be correctly pronounced. Please indicate either the phonetic spelling of your name or a familiar word that rhymes with your name. Syllables are separated by a dash and stressed syllables are capitalized. For example:
Raul Gonzalez would be rah-OOL gan-SAH-les
or
Nqoc Nguyen would be nank nuhWEN sounds like knock WIN

PARENT OR GUARDIAN INFORMATION

Parent(s) name(s) (please include both first and last names) or the name of another adult who will attend the breakfast with you. Please be sure to include your parents' phone number(s) (more than one if necessary), so we may call for clarification if necessary.

FIRST PERSON


SECOND PERSON

Student's Attributes and Activities
CHARACTER ATTRIBUTES
Include 1 example for each of the 6 attributes listed below. Use examples of situations where you exhibited the following character attributes: trustworthiness, respect, responsibility, fairness, caring, and citizenship.

Please list concrete examples of your participation and involvement in the community. All volunteer activities—including civic, faith-based, and charitable—are appropriate.

Select two character attributes or activities from those listed above that you want to be mentioned when you are introduced. Comment on how you were involved in making the lives of others better.

REFERENCE PERSON OR ORGANIZATION INFORMATION

Include the name and contact information of a person at an organization who can be contacted regarding your community involvement or volunteer participation. This should be the person or organization that benefited the most form your contribution.

UPLOAD STUDENT'S PHOTO

Use this section of the form to upload the student's head-and-shoulder shot. Maximum fill size is 10MB. Allowed format types are jpg, jpeg, png, gif. Use your last name, first name as the file name. NOTE: Send your photo as soon as possible but no later than midnight, March 2, 2017.

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Maximum size 10MB

SUBMIT YOUR PROFILE

Thank you for completing the 2016 Catalyst for Positive Change student profile form. Take a minute to review your entries and once you are certain all information is correct type the the four characters displayed below into the box above them and click the "Submit" button.

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