VAPLP Mentor Confirmation

Name(Required)

First Last

Dietary Needs

Access Needs

COVID Vaccine Card(Required)

Please make sure your name and vaccinations are viewable and up to date.

Max. file size: 50 MB.

Vehicle Information

This will be used to obtain a parking pass for Weekend 2.

Make

Model

Year

Color

License Plate Number

Travel + Compensation Stipends

Please read through the travel stipend policy below. Every mentor will be compensated $300 for their time & support. The following fields in this section inform what we need to distribute funds your way if you decide to opt in to any or both.

Opt In/Out(Required)

Opt In: Travel Stipend + Compensation Stipend

Opt In for Travel Stipend / Opt Out for Compensation Stipend

Opt In for Compensation Stipend / Opt Out for Travel Stipend

Opt out for both: I would like to opt out of the travel + compensation stipends. I confirm that I will be paying for the cost of travel fully on my own.

Bank Name

Routing Number

Account Number

Please fill out this W-9

Please attach a voided check.

Max. file size: 50 MB.

If you don't have a voided check, no worries.

Please sign the waivers + releases here