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Mentor Application

Please fill in all the information. The more detailed you are the better we can pair you up with a compatible mentee.

Name:
Telephone:
Local Address:
City, State, Zip
Year in School: Sophmore Junior Senior
ID #: Email: Credits Earned:
Major:
Ethnicity: African American Native American Hispanic Caucasion
Asian American Hmong Other

Why do you want to be a mentor?

What activities/organizations are you involved in, on campus/in the community?

Which of these activities would you participate in with your mentee?

Study Groups:   Athletic Events:
MEC Events & Activities:   Tutoring:
Library Orientation:   Campus Events:
Career Exploration:   Cultural Events:
Tour of Campus:      
Other:

 

Please list two references. One must be a Faculty/Staff member at UW Oshkosh.

Name:
Occupation:
Phone #:
Name:
Occupation:
Phone #:

 

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   Last Updated: April 2006