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  • Affirmation

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This form must be signed, and enclosed with a mailed School Application for a Participating School, by any Mentor selected by that Participating School who is not a teacher or administrator at that or any other Participating School or an employee of a school system that includes a Participating School.

NAMEName: ___________________________________________________________STREET ADDRESS

Mailing Address: ___________________________________________________________TOWN/STATE/ZIP:

Town/State/Postal Code: ___________________________________________________________PLACE OF EMPLOYMENT

Place of Employment: ___________________________________________________________POSITION

Title/Position: ___________________________________________________________

 

I affirm that:

  • I have not been convicted of, nor am I presently charged with, and felony offense.
  • I agree to follow all Cappies rules and procedures.

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