First-Year Mentoring Experience Application

Please take time to carefully answer these questions. They will be used to skillfully match you with a volunteer Mentor. All responses will be kept confidential and files will be kept secure. This Application can be typed or written legibly. Please return via email to Professor Williams West. Please email aumentoringprogram@adelphi.edu or call 516-877-3182 with any questions or concerns.

Email Address

Confirm Email Address

First Name

Preferred Name

Last Name

Mailing Address

Country

Street

City

Region

Postal Code

Home Phone

Mobile Phone

Gender

I choose to be identified as

Most Recent High School or Academic Institution

Current GPA

What is your preferred method of communication?

Tell Us About Yourself

Please describe your interests, goals and aspirations.

Write a brief statement on why you would like to participate as Student Mentee in the First Year Mentoring Experience.

What do you want to learn about college from your Mentor?

Please list any hobbies or interests you have:

What clubs or groups, if any, do you belong to?

Complete this sentence “My favorite subject in High School was”

Complete this sentence “My least favorite subject in High School/College was”

What qualities would you like in a Mentor?

What individual has served as a role model for you and why?

If you could recommend one book for a peer to read, what would it be and why?

What academic major would you like to pursue in college? You may also indicate “undecided”.

Please write a brief statement about why mentoring is important:

References

Please list two references (please include at least one personal and one School teacher or personnel reference) Note: Letters of recommendation are not necessary, only contact information.

Reference 1

Name

Phone Number

Relationship

Reference 2

Name

Phone Number

Relationship

I certify to the best of my ability that the information provided on this application is true and accurate. I also understand that misinformation knowingly provided here, and on subsequent Peer Mentoring Program application forms, is grounds for dismissal from the Peer Mentoring Program.

Yes

Portions adapted from materials provided by Mentoring Partnership of Long Island, The ABC’s of Mentoring, and California Governor’s Mentoring Partnership