Mentee Application

Please fill in the appropriate responses:

Last Name:
First Name:
 
Address:
Apt#:
 
City:
State:
Zip:
 
E-mail Address:
 
Phone Number:
 
Student ID #:
 
Number of semesters enrolled:
GPA:
 
Remedial requirements to be completed:
 
Please describe how a mentor can be of assistance:
 
Please indicate the days and times that you are available to meet with your mentor:
 
Please indicate in which of the following area(s) you need assistance:
Tutorial
 
Referral to the LRC
 
Study skills
 
Time management
 
Goal Planning
 
Negotiating “the system”
 
Explanation of the academic grading policy
 
Formulation of “Success Strategies”
 
Personal
 
Referral to Counseling
 
Networking