Rockstreet Empowerment Initiave - ROCKSTREET MENTORSHIP PROGRAM FOR SENIOR SECONDARY SCHOOL STUDENT (RMPS)

* FIRST NAME

* LAST NAME

* WHAT NAME/NICKNAME DO YOU PREFER TO BE CALLED?

* DATE OF BIRTH

* AGE

* PHONE NUMBER

* EMAIL ADDRESS

* NAME OF SCHOOL

* SCHOOL ADDRESS

* HOME ADDRESS

EDUCATIONAL LEVEL

* WHAT CLASS ARE YOU IN?

If you are in third term of school, state what class you will be in by September.

SSE ONE
SSE TWO
SSE THREE

* HAVE YOU GRADUATED FROM SECONDARY SCHOOL?
Yes
No
Maybe

* HAVE YOU TAKEN ANY EXTERNAL EXAMINATIONS? IF YES, STATE THE TYPE?

* WHAT EXAMINATIONS ARE YOU TAKING THIS YEAR?
SSCE, UTME, POST UTME
GCE & UTME
SSCE , UTME, POST-UTME, FOUNDATION DIPLOMA
SSCE, UTME, POST-UTME, SAT, IELTS
UTME
Other

* WHAT SUBJECT DO YOU HAVE THE MOST PROBLEM WITH?

* WHAT GRADE BEST DESCRIBES YOU?
A+ ( 70 and above)
B+ (60 -69)
C+ (50 -59)
D+ (40-49)
E (39 and below)

* HAVE YOU HAD ANY PARTICIPATION IN CO-CURRICULAR ACTIVITIES IN YOUR SECONDARY SCHOOL? IF YES, MENTION THE ACTIVITIES

CAREER SELECTION

Give insights to your career choice.

* YOUR FIRST CAREER CHOICE

* YOUR SECOND CAREER CHOICE

* YOUR THIRD CAREER CHOICE

* WHAT INFLUENCED YOUR FIRST CAREER CHOICE?

(Reasons may be parental influence, peer influence, interests, strength, past experiences etc)

* WHERE DO YOU SEE YOURSELF IN FIVE YEARS?

* WILL YOU LIKE TO HAVE ACCESS TO INTERNATIONAL OPPORTUNITIES?
Yes
No
Maybe

* WHAT ARE YOU CAREER DREAMS AND ASPIRATIONS?

* WHAT IS YOUR FIRST CHOICE FOR A UNIVERSITY EDUCATION?

* WHAT IS YOUR SECOND CHOICE FOR A UNIVERSITY EDUCATION?

* WHAT INFLUENCED YOUR CHOICE OF A UNIVERSITY?

RMPS PROGRAM EXPECTATIONS

Let's rate what you need for us.

Would you like to subscribe to our SSCE and UTME tutorial?
Yes
No

Why did you join the RMPS program?

Would you like to be paired with a mentor in your chosen career/field?
Yes
No

Would you like to have access to counselling on subject and course selection to optimize your chance of entering the university?
Yes
No

Would you like to gain IT skills before entering the university?
Yes
No

What other skills will you like to learn?

PARENTAL CONSENT

This section is meant for parents/guardian only. By placing your name and signature as a parent, you agree to: have your child participate in the free mentorship boot camp; participate in tutorials and close progress monitoring by Rockstreet officials; to be a part of a Telegram/Whatsapp group updating new opportunities and activities.

PARENT/GUARDIAN NAME

PARENT/GUARDIAN EMAIL ADDRESS

PARENT/GUARDIAN DATE

PARENT/GUARDIAN SIGNATURE