HU-LINC Middle School Mentor Renewal

The following renewal form should be completed at the end of each academic year by all persons who were designated as HU-LINC Mentors in order to confirm your continued participation, campus location, and contact information. If you need assistance, contact:

Alfonso Ramirez (aramire2@houstonisd.org) 713-892-7644 or
Alice Hahn (ahahn@houstonisd.org) 713- 892-6103.

Please provide the following personal contact information (required if marked with *). If you are changing schools, please provide information for your new location:
First name	MI
Last name
HISD Empl ID#
School		Campus #
Admin. District
School FAX
Work Phone
Home Phone
Mailing address
Address (cont.)
City
Zip code
Summer E-mail
HU-LINC Laptop INFORMATION	Model	ID/Serial #

Yes, I have read and accept the responsibilities of a mentor as set out in the description, Mentor's Duties/Benefits .

Why do you want to continue as a HU-LINC Mentor? (Explain briefly in box below)

Do you (or does your school) have a working relationship with one or more elementary schools in your feeder pattern, other than your assigned HU-LINC school(s)?
Yes No. If yes, please list the school(s) and describe the relationship in box provided below:

Please list the names of Elem. Science Lead Teachers (and Schools) currently assigned as your partners, including any projects or activities you have accomplished in partnership.