The Man Center Mentoring Application Form Semester: Spring 2013 Please fill in each blank and submit to us. You will receive a confirmation that your application has been received. The information provided below will be used for the task of matching peer mentor/mentee relationship. Mentor Application First Name: Last Name: Mailing Address: City: Student ID #: State: Home/Cell phone: E-mail address: Cumulative GPA (GPA must be 2.5 or greater) Current classification: Graduate Undergraduate Birth date: Married: Children: Degree Major/Minor: How or from whom did you learn about The Man Center? What languages do you speak? Other Interests/Hobbies: ZIP: To match prospective mentees with your available schedule, please be specific as possible and list all your available days and times this semester Monday: Times Tuesday: Times: Wednesday: Times: Thursday: Times: Friday: Times: Who has been the most influential person/mentor in your life and why? What do you hope to gain personally and professionally from being a mentor? Why do you think you will be a good mentor? Have you been a mentor/mentee before? If so, what did you learn about yourself from that relationship? Please provide a two to three sentence bio for our website Check here __ if you want a recommendation letter of completion for your resume (portfolio). Please submit 2 references who can attest to your character and ability to be a mentor: Name: Relationship E-mail: Please send a photo of yourself (head and shoulders) to [email protected] Send a copy to my email for my records (Mr. Arnold). By submitting this application, you confirm that all information provided is accurate to the best of your knowledge and you will represent the Man Center with the highest respect.
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