Mentor Application Form

Multicultural Peer Mentorship Program (MP²) College of Design Iowa State University

MENTOR/ MENTEE APPLICATION FORM

The application process is necessary to ensure the quality of the mentorship group and to verify each mentor’s ability to successfully assist their mentee.

Full Name: ______

ISU E-mail Address: ______Telephone Number: ______

Local Address: ______Hometown: ______

Ethnicity (please mark all that apply):

Class Standing:

Major(s) - ______

Minor(s) - ______Cumulative GPA - ______

What do you hope to accomplish by participating in the Mentorship Program? ______

What are qualities are you looking for in a mentee/mentor? ______What do you hope to gain from this program? ______

Mentee (check here and make your selections below.) Mentor (check here and make your selections below.)

I would like my mentor to have a program of study (major): I would like my mentee to have a program of study (major): the same as mine similar to my field the same as mine similar to my field

in any design major in any design major

I would like to meet with my mentor: I am willing to meet with my mentee: 30-60 minutes per week 1-2 hours per week 30-60 minutes per week 1-2 hours per week

2-3 hours per week when time is available 2-3 hours per week when time is available

I would like to communicate by: I would like to communicate by: ISU email phone either ISU email phone either

I would like my mentor to be**: I would like my mentee to be**: male female either gender male female either gender

I would like my mentor to be**: I would like my mentee to be**: of the same ethnicity as of the same ethnicity as of the same country of me me origin not of the same ethnicity not of the same ethnicity not of the same country as me as me of origin any ethnicity any ethnicity any country of origin

I would like my mentor to be: I would like my mentee to be: Sophomore Junior Senior either Anyone Name if you have a preference: Name if you have a preference:

Benefits of being a Mentor:

Benefits of being a Mentee: