Contact informationName * Required First Last Address * Required Street Address City State / Province / Region ZIP / Postal Code Date of birth - must be yyyy/mm/dd format * Required YYYY slash MM slash DD Phone number * RequiredEmail * Required Preferred method of contact * Required Phone Email Mail Note: Mentees will be contacted by a member of the Alumni Association team and will be required to attend a brief, one-on-one interview on campus, at the mentee’s convenience.Program / Work InformationProgram name * Required Program year * Required Second Third Final (Right now, the program is only open to students in their second, third, or final year of studies. Students in a one-year program would be in their final year.)How did you hear about the program? * Required Website Poster Presentation Event A friend Other Select all that apply.Additional information The following information is requested as it will help us best match you with a mentor.What is your ideal mentor's job title? * Required What are some of the skills and experiences that your ideal mentor would possess? * RequiredAre you currently involved in any other clubs, programs, teams, or on-campus groups ? If so, please describe. * RequiredPlease briefly describe your current and prior volunteer experience (include titles, employers, etc.) * RequiredPlease briefly describe your current and prior work experience (include titles, employers, etc.) * RequiredThe Mentorship Program runs for approximately seven months (from October to April). Are you able to commit to the entire length of the program? * Required Yes No Mentors are required to connect (either in person, on the phone, or via e-mail) with their mentee for at least one hour, once per month for the entire duration of the program. Are you able to commit to connecting for an hour at least once per month? * Required Yes No Send me a copy of this form by email NameThis field is for validation purposes and should be left unchanged.