Student Alumni Mentoring (Mentor)

Mentor Application

Name: *

Age: *

Graduation Year(s): *

Major/Minor(s): *

Email: *

Address: *

City: *

State: *

Zip: *

Home Phone Number (999-999-9999): *

Preferred method of Communication? *

Current Industry: *

Company Name: *

Years of Experience: *

Current Position Title: *

Other Business/Organization Affiliations involved in?

Personal Hobbies and/or interests:

Student organizations involved in when you were a student?

Briefly explain why you are interested in being a mentor and your expectations of the program?

What specific personal/professional qualities do you bring?

How did you hear about the program?

Interested in job shadowing?

Yes
Maybe
No

*By signing this form, I agree to all terms and conditions of the Student Alumni Mentoring program. I understand that this program requires two evenings a semester and regular communication. I commit to building a mutual relationship with my mentee, to hear about new dreams and challenges, to share my own stories, to respect the difference between us, and provide guidance to the best of my ability.

Signature (initials): *