Name:

919 Number:

Major:

Year:
Sophomore Junior Senior Graduate

Living:

ON CAMPUS OFF CAMPUS

Interests and Hobbies:

Why do you want to be a mentor?

For matching purposes, what interests or qualities would you share with the mentees?

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 have gained mastery in and/or consider being your strengths? (i.e., time management, study skills, meeting people, doing homework, public speaking, sticking with tasks until they are done, etc.)

What kind of activities do you like to participate in?

What kind of music do you like to listen to?

Would like to have a group meeting with other mentors and mentees, or would you prefer one-on-one meetings with your mentee?

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

Requirements for Mentors:

• Mentor must be a full time student.
• Mentor must meet with his / her mentees at least 4 times a month. Two of those sessions must be study sessions.
• Mentors and mentees must attend 2 group sessions (mentor must attend at least one of them).
• As an example to the mentees, mentor must maintain at least a 2.50 GPA.
• Mentor must accumulate 120 points a semester to remain in the program.
• Mentor must fill out and submit the monthly report (activities) by the 5th of each month.
• Mentor must meet with his / her faculty advisor at least 3 times each semester.
• Mentor must attend the leadership and organizational training provided by IIC.
• Mentor 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)