S.T.R.O.N.G. MENtoring Mentor Application

Name Name * First Last
Date Date * / MM / DD YYYY
Major *
Minor (if applicable)
Phone Phone * - ### - ### ####
Email *
Current Cumulative GPA
Classification *

Classification Sophomore Junior Senior Gradute Student
T-Shirt Size

T-Shirt Size Small Medium Large X-Large XX-Large XXX-Large
Mentoring Information
Have you served as a mentor previously?

Have you served as a mentor previously? Yes No
If yes, with what program & when?
Are you willing to participate in a mandatory training session?

Are you willing to participate in a mandatory training session? Yes No
Are you willing to meet with your mentee at least twice per month, including planned activities?

Are you willing to meet with your mentee at least twice per month, including planned activities? Yes No
If no, explain:
Please explain why you want to be a mentor:
What outcomes do you want from this relationship?
List hobbies, qualities, special skills or other attributes do you freel you have that would benefit a mentee:
Describe a situation in which you were involved with another student/adult and which demonstrates that you are a good listener, empathic, and that you promote the welfare of others:
What do you consider the most important issue facing today's men of color pursuing a higher education? and how would you address this with your mentee?
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I certify that the statements made in this application are true and correct, and are given voluntarily.
Type Full Name *