Peer Mentoring   Requirements   Protege Application

Protégé Application

First Name:
Last Name:
Gender:	MaleFemale
Home Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Home Phone:
Home Email Address:
Cell Phone:
Major:
What is your preferred method of contact?	Phone Email IM - list: Text Facebook - list: Other - list:
How did you hear about the Mentoring Program?
To help us find a mentor for you, please complete the following information:
Do you plan to:	live on campus live at Vulcan Village live in off-campus housing that is not your permanent residence commute from permanent residence
Are you over the age of 25?	Yes No
Do you plan to work off-campus?	Yes No
Do you plan to work on campus?	Yes No
Will you start cal as a freshman or a transfer student?	Freshman Transfer
Please indicate which programs/organizations/sports you participate in or plan to participate in.
Academic Development	Intramural Rugby
Band	Intramural Softball
Black Student Union	Intramural Racquetball
Campus Ministry	Intramural Flag Football
Campus Radio Station	Intercollegiate Sports	- list:
Campus TV	Office for Students with Disabilities (OSD)
Clubs within Your Academic Major	Outdoor/Nature Club
Cheerleading	Rainbow Alliance
Choir	Service Organization
Dance Team	Ski Club
Equestrian Team	Student Activities Board
Greek Organization	Student Government
Honors Program	University Newspaper
Intramural Volleyball	University Yearbook
Intramural Basketball	Volunteer Organization
Intramural Hockey	Other	- list:
What are some hobbies or activities that you especially enjoy? (reading, crafts, jogging, fishing, hunting, playing sports, watching sports, scrapbooking, horseback riding, dance, etc.)
When we match new students with our mentors, we typically look at the following to match you: first your academic major, in addition to your answers in Questions 1 - 3. Do you have any other preferences for how you are matched (such as ethnicity, international student status, sexual orientation, gender, etc.)? If so, please specifically describe your preference below and we will do our best to accomodate your request.
Protege Engagement Survey
I hope my mentor wants to meet with me:	Choose one weekly monthly twice a semester once a semester
I want my mentor to contact me:	Choose one daily weekly monthly twice per semester once per semester just once before school starts. Then, I would prefer to contact my mentor when I need him/her.
I hope my mentor:	Choose one is outgoing and is involved in on-campus activities. is somewhat reserved, enojys staying in and chatting, reading, going to movies.
I prefer that my mentor:	Choose one is in my major was an undecided major (or changed majors) at some point during their college career is in a similar activity, such as: Choose one Band Choir Honors Program Office for Students with Disabilities If you prefer another club or activities that you prefer (instead of major), please list here:
I selected a major, but I'm not sure I'll stay with that major.	Choose one Yes No
By submitting this form, I understand the information above will be shared with my mentor.