Your Name: ______________________________________________
Title:____________________________________________________
College: _________________________________________________
Work Address:
___________________________________________
________________________________________________________
Work Telephone Number: ___________________________________
Work
Fax Number: ________________________________________
E-mail Address: ___________________________________________
Are you interested in having a
Mentor? Yes______
No______
If you wish to have a
mentor, please tell us a little about yourself.
How long have you worked in Student
Affairs?_____________________
How long have you worked
in your present position?________________
Briefly describe your
past employment in student affairs.
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
If this is your first
employment in student affairs, briefly describe your
most
recent employment.
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
What would you like to
learn from a mentor?
___________________________________________________________
___________________________________________________________
___________________________________________________________
Please list any personal
preferences you have in a mentoring partner.
___________________________________________________________
___________________________________________________________
___________________________________________________________
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