Name:

High School GPA:

T-Shirt size:
XS S M L XL XXL

Room assignment (if you do not know, write I DON’T KNOW):

Interests and Hobbies:

Why do you want to be a mentee?

What do you expect from a mentor?

For matching purposes, what interest or qualities would you like your mentor to have?

The following information will assist us in making the best possible mentor/mentee match. Please help us by being as accurate and thorough as possible in your responses.

Do you consider yourself to be an extrovert or an introvert?
Extrovert Introvert

Would you like to be paired with someone just like you?
Yes No

What areas would you say you struggle with the most or may struggle with in college?
(i.e., time management, study skills, meeting people, doing homework, public speaking, sticking with tasks until they are done, etc.)

What major or general areas are you interested in?

Would you like to meet with a group of other mentees and mentors, or would you prefer one-on-one meetings with your mentor?

If there is anything else that you can think of that would help us ensure a good match between you and your mentor, it would be greatly appreciated.

Requirements for Mentees:

• Mentee must be a full time student.
• Mentee must meet with the mentors at least 4 times a month. Two of those sessions must be study sessions.
• Mentees and mentors must attend 2 group sessions (mentees must attend all of them).
• Mentee must accumulate 120 points a semester to remain in the M.O.R.E. program.
• Mentee must fill out a monthly evaluation form.

I hereby acknowledge that I have read, understood and agreed to abide by the
requirements of this position.


Signature of Student (type full name here)