S.T.R.O.N.G. MENTORING: MENTEE APPLICATION

Complete the information below as best you can to be assigned a mentor that best matches your interest & aspirations.

Name Name First Last
Date Date / MM / DD YYYY
Major
Minor
Local Address Local Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone - ### - ### ####
Email
Classification
Current GPA
Will you commit to participating in the Mentoring Program for a minimum of one year from the time you are matched with a Mentor?

Will you commit to participating in the Mentoring Program for a minimum of one year from the time you are matched with a Mentor? YES NO
Are you willing to communicate regularly and openly with Mentor/Advisor, participate in mentoring activities, and provide feedback regarding any difficulties during your participation in the mentoring program?

Are you willing to communicate regularly and openly with Mentor/Advisor, participate in mentoring activities, and provide feedback regarding any difficulties during your participation in the mentoring program? YES NO
Explain why you want a Mentor?
What outcomes do you want from this relationship?
List hobbies, personal interest:
How will you ensure that you will maximize the benefits of having a Mentor?
What are your long term career goals?
I certify that the statement made in this application are true and correct, and are given voluntarily (Type your full legal name below)