Mentor Form - Wheeling Jesuit University

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MENTOR APPLICATION FORM

Last Name: First Name:

How are you associated with Wheeling Jesuit University?

Current Student

Alumnus

Employee

Other:

FOR WORKING ADULT:

Profession:

Mailing Address (If off-campus):

Home Number: Work Number:

Email:

FOR CURRENT STUDENT:

Box Number: E-mail:

What is your intended major: College GPA:

Campus Extension:

Ethnic Group:

African American

Asian

Hispanic

Native American

Other, Please State:

Please check any of the following:

Yes! I would like to mentor a multicultural student for the year 2003-2004!

Yes! Mail me more information about the Mentoring Program.

IF YOU WOULD LIKE TO BECOME A MENTOR, FILL THE FOLLOWING:

Activities at Wheeling Jesuit University:

Some of my interests and hobbies are:

I want to be a Mentor because:

Suggestions or Comments:

Thank you for taking the time to complete this application. We will be pairing you up with your mentee and we will contact you as soon as that is accomplished. If you have any questions, please contact us directly at 304-243-2285. Thank you for volunteering!