APPLICATION TO PARTICIPATE IN THE RHODE ISLAND PARANORMAL RESEARCH GROUP AND SOCIETY'S STUDENT MENTOR PROGRAM
MY PROJECT IS FOR MY
*
Please Select
SENIOR PROJECT
EXTRA CREDIT
Student's Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Phone Number
-
Area Code
Phone Number
Your E-mail
*
____________________________________________________
Project Due Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
School Name
*
Teacher or Guidance Counselor's Full Name
*
First Name
Last Name
School Contact Phone Number
*
-
Area Code
Phone Number
School Contact's E-mail
*
PLEASE LIST ANY HEALTH ISSUES, INCLUDING ANY PRESCRIPTION MEDICATIONS YOU MAY BE TAKING, THAT WE NEED TO BE AWARE OF.
*
READ THE FOLLOWING LEGALLY BINDING INSTRUMENT VERY CAREFULLY!
I shall at all times show respect and obey the instructions of my mentor.
As a willing participant in The Rhode Island Paranormal Research Group and Society's student mentor program, I agree accept with full understanding the following:
I shall at all times, including after successfully finishing the program and in the event of termination of same, maintain absolute confidentiality concerning any and all information concerning any and all clients I may have contact with or have been privy to. I acknowledge, understand and agree I shall be held legally liable and accountable, both civilly and criminally, for any compromise concerning a confidentiality agreement. The Rhode Island Paranormal Research Group and Society may have with any client whatsoever. I acknowledge and fully agree and understand that any and all material used my project's presentations without exception must be approved and cleared by the involved client(s), the Mentor and or the Group Director before being released.
The Rhode Island Paranormal Research Group and Society shall terminate my participation in the student mentor program if, at any time, it feels I am not meeting the obligations of attendance and participation as is required of the program.
I am aware that there are inherent dangers in my participating in paranormal investigation and research and have discussed my involvement fully and without reservation with my parent or legal guardian these risks for which in no way whatsoever shall I hold any client, any member of their their families or associates there of, as well as The Rhode Island Paranormal Research Group and Society in part or as a whole responsible for any and all repercussions, both physical and psychological, that (albeit unlikely) can occur as the result of my supervised participation.
I as the applying mentee, hereby affix my electronic signature to this legally binding instrument affirming that I have read, understand and fully agree without reservation or coercion the above terms of my participation in The Rhode Island Paranormal Research Group and Society's student mentor program
Student's Electronic Signature
*
First Name
Last Name
I, as the applying mentee's PARENT or LEGAL GUARDIAN, do hereby affix my electronic signature to this legally binding instrument affirming that I have read, understand and fully approve without reservation or coercion the above terms of my child or legal ward's participation in The Rhode Island Paranormal Research Group and Society's student mentor program
Parent or Legal Guardian of student Electronic Signature
*
First Name
Last Name
NOTARY PUBLIC USE ONLY
Enter the message as it's shown
*
ALL STATEMENTS AND ENDORSEMENTS ARE VERIFIED BY TELEPHONE BEFORE THIS APPLICATION CAN BE APPROVED. INCOMPLETE APPLICATIONS WILL BE REJECTED. PLEASE INCLUDE AN INTRODUCTORY LETTER!
Submit Form
Clear Form
Should be Empty: