REQUEST A MENTOR
Mentee
Semester
Please Select
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
Format: (000) 000-0000.
Mobile
Format: (000) 000-0000.
Classification
Please Select
New Freshman
Returning Freshman
Sophomore
Other
GPA
Please Select
New Freshman
Returning Freshman
Sophomore
Other
College Major
College Credit Hours Earned
Degree
AA
AS
AAS
Other
Please list any special interest, skills, or hobbies
Favorite/least favorite things about college
What topics would you like to address/discuss with a mentor?
What are your expectations for this program?
Please select the words which describe your personality:
Spiritual
Adventuresome
Confident
Sensitive
Happy
Moody
Quiet
Shy
Nervous
Outgoing
Talkative
Receptive
Open-minded
Strong-willed
Self-aware
Adaptable
Purposeful
Focused
Communicative
Friendly
Other
Back
Next
Please indicate below all of the hours that you are available for mentoring
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
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