HU/UB Mentor-Tutoring Program Application

HU/UB Mentor-Tutoring Program Application

Upward Bound
HAMPTON UNIVERSITY

Upward Bound

Mentor Program

Overview

The Upward Bound Mentor Program is designed to match Upward Bound participants with both graduate and undergraduate college students who are able to provide social, academic, and motivational support and guidance as they matriculate through high school and transition to college. Upward Bound participants are first-generation and/or low-income students attending
high school at either An Achievable Dream, Denbigh, Heritage, or Warwick High Schools.

Mentors will work to realize the mission of Upward Bound, which is to assist first-generation, lowincome students to successfully complete a program of rigorous study in high school that will enable them to earn a degree within six years of high school graduation. Mentors will relay the mission to their mentees, and make a commitment to build strong peer connections by fostering a welcoming cultural environment at Hampton University. Being a Mentor is challenging and requires dedication and perseverance, as with all relationships, you must be willing to work to build trust among mentees. This takes time, and most importantly commitment. We encourage you to establish a personal relationship with your mentees with the goals of connecting, equipping, and educating students as they prepare to transition to institutions of higher learning.

Criteria

• Possess an interest in developing meaningful relationships with students
• Must be willing to commit to scheduled meetings and activities
• Must be a junior, or senior in good academic standing
• Must have a 3.0 cumulative GPA or higher
• Must be socially cleared through the office of Judicial Affairs and Housing

Name*

First NameMiddle InitialLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
HUID*
HU Email*
Classification*

JuniorSeniorGraduateProfessional
What's your career field?
Current GPA*
Major*
Minor
What is the highest degree you will seek?*
High School Attended*
City/State*
High School Graduation Year*

Please indicate your availability on the following days:
Monday*
Tuesday*
Wednesday*
Thursday*
Friday*
Saturday*
Sunday*
What's your true colors personality color?*

GreenBlueGoldOrange

In case of an emergency, please contact:
Emergency Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Describe your interests and hobbies below.
Describe the qualities you possess that would make you a successful mentor
Do you have a preferred grade level or background of a mentee? If so, what are those preferences?
Describe how you would utilize your academic and social experiences to mentor participants in the Upward Bound program.

Please list your previous work experience.

Experience 1
Company (Experience 1)
Position (Experience 1)
From (Experience 1)
To (Experience 1)
Duties (Experience 1)

Experience 2
Company (Experience 2)
Position (Experience 2)
From (Experience 2)
To (Experience 2)
Duties (Experience 2)

Please list two people, unrelated to you, who can serve as character references for you.

Reference 1
Name (Reference 1)
Relationship (Reference 1)
Phone Number (Reference 1)
Please enter a valid phone number.
Number of Years Known (Reference 1)

Reference 2
Name (Reference 2)
Relationship (Reference 2)
Phone Number (Reference 2)
Please enter a valid phone number.
Number of Years Known (Reference 2)
I certify that the information supplied is correct to the best of my knowledge. I grant permission for you to contact the references provided. I understand that the Upward Bound Mentoring Program reserves the right to deny acceptance to any mentor and to terminate a mentor from the program. I also understand and agree to the duties and requirements described in the application packet.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: