BECOME A MENTOR
Semester
Fall
Spring
Summer
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Full Name
*
First Name
Last Name
Student ID#
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail Address
*
Home Phone
-
Area Code
Phone Number
Mobile
-
Area Code
Phone Number
Classification
New Freshman
Returning Freshman
Sophomore
Other
GPA
College Major
Degree
AA
AS
AAS
Other
College Credit Hours Earned
Expected Graduation Date
Are you currently a part-time worker in another department at ANC?
Yes
No
Previous mentor experience?
Yes
No
If yes, please list.
Please list any special interest, skills, or hobbies
Favorite things/least things about college
What does it mean to be a mentor?
Please select the words which describe your personality:
Spiritual
Adventuresome
Confident
Sensitive
Happy
Moody
Quiet
Shy
Nervous
Outgoing
Talkative
Friendly
Adaptable
Creative
Focused
Open-minded
Service-oriented
Caring
Good listener
Stable
Leadership abilities
Reliable
Committed
Nonjudgmental
Discreet
Patient
Sense of humor
Tolerant
Purposeful
Helpful
Self-aware
Respectful
Communicative
Other
Please indicate below all hours that you are free to assist students.
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
8-9 am
9-10 am
10-11 am
11-12 pm
12-1 pm
1-2 pm
2-3 pm
3-4 pm
Submit
Should be Empty: