Mentor Application Form

Mentee Application

CORE
Mentoring is a partnership between two people based on commitment to the mentoring process, common goals/expectations of the partnership, and mutual trust and respect.
Mentoring is a “get and give” experience with the goal of providing a rich and rewarding experience for both partners. We ask you to share your information so the program manager can match you in a mentoring relationship. Both you and your recommended mentor will have the opportunity to agree to the pairing before you are assigned to work together

We encourage the participation of mentors and mentees who support our
mission and are willing to contribute. The information provided through this form will be kept confidential and will help us determine the most satisfying and appropriate opportunity for you.
Name

PrefixFirst NameLast Name
Birth Date

MonthDayYear
Email
example@example.com
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
College/School
Current grade, date of graduation or last level completed
Why do you want to work with a mentor?
Describe your strongest competencies (i.e., knowledge, skills, and abilities):
Describe the competencies you would like to strengthen and/or leverage through working with a mentor:
List any positions, activities or groups you are or have been a part of:
What are your interests, hobbies and/or work?
What do you think a mentor can learn from you?
If any, please list any preferences or type of mentor you would like to have:
Select your available days
From

Hour Minutes

AM/PM Option
To

Hour Minutes

AM/PM Option
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Mentee Application