Mentor Application Form

First Name*

Last Name*

Street Address*

City*

State*

Zip Code*

Email Address*

Phone Number*

What is the best way for us to contact you? *

Is texting you acceptable?

Yes

No

Gender

Male

Female

Do you speak another language?

Yes

No

If so, what other language(s)?

Do you have any postsecondary education?

Yes

No

If so, what area(s) of study?

Please indicate the best evening of the week for the pre-selection two-hour mentor training session

Monday

Tuesday

Wednesday

Thursday

Friday

Please tell us about yourself, including current career, hobbies, areas of interest, etc. (2-3 sentences)*

What interested you about becoming a mentor? (2-3 sentences)*

What do you look forward to in the mentoring relationship? (2-3 sentences)*

Do you have questions about mentoring that you would like to have us address at our informational meeting?*

College Information