Discipleship Mentor Application Form

Mentor Application

Fill out the following form if you are interested being a mentor.
Contact Information
Name*

First NameLast Name
Email*
Cell Phone*

Area CodePhone Number
Best way to contact me:*

TextEmailBoth
Educational background:*
Hometown:*
Work background:*
Please provide a digital picture of yourself (and your family, if you would like)*

Upload Photo
This will be shared with your mentee prior to your first meeting. Cancelof
Mentor Interest
Why you are interested in serving as a mentor:*
Pick a few of the hobbies you enjoy doing and write why:*
A few words about my family:*
Job Information
Current and past career(s) or areas of interests:*
Religious Affiliation
Church Membership:*
Denomination or Affiliation you most closely identify with:*
Hobbies
Mark all hobbies, providing more details after:*

Watching TVCraftsSportsReadingTravelingVideo GamesMusicComputers/WebMinistryOutdoor Activities
Details:*
Personality
How would a close friend describe you?*
How do you describe yourself (mark all that apply)? *

OutgoingReservedSocialBusyListenerTalkativePassiveActiveBoldBalancedQuietFriendlyFamily-orientedGenerousWillingInitiating
Other important qualities:
What are you looking for in a mentee (mark all that apply)? *

OutgoingReservedSocialBusyListenerTalkativePassiveActiveBoldBalancedQuietFriendlyFamily-orientedGenerousWillingInitiatingSimilaritiesNo preferenceOther
What would you like to get from the mentor/mentee partnership?*
What does mentorship mean to you?*
What’s something that sets you apart from most people?*
Is there anything you would like to add?
Southwestern College
100 College Street | Winfield, KS 67156-2499
1-800-846-1543
Should be Empty:

Mentor Application

Contact Information

Mentor Interest

Job Information

Religious Affiliation

Hobbies

Personality