College Connection Mentor Application

By completing this form, I am indicating my willingness to serve as a mentor for the 2010-2011 academic year.

Apply

* = Required

First Name*:

Last Name*:

Date:

Title:*

Company Name:*

Direct Telephone*:

Email*:

Description of Business:*

Degree(s) Received & Major/Emphasis:*

University(s) & Year(s):*

I have previously participated in a formal Mentorship Program.

I was referred to the mentorship program by:*

Answering the following questions will assist us in making an appropriate match.

1. Briefly describe your primary job responsibilities in your current position:*

2. List the titles of previous jobs you have held:*

3. In order of importance, select up to 4 career areas in which you feel comfortable mentoring a student (indicating as A= most comfortable, D = least comfortable). If “Other”, please specify.*

	Accounting
	Business Management
	Investments / Insurance
	Human Resources
	Marketing / Advertising
	Entrepreneurship
	Manufacturing and Engineering
	Graphics Design
	Banking
	Technology
	Sales
	Other (Specify)

4. Describe any expertise not captured above or listed as “Other”:*

5. Briefly describe your background in the areas ranked above:*

6. Optional: Other special considerations you prefer us to base your match on, such as ethnicity, gender, high ability, organizations, etc:

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College Connection Mentor Application

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