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Mentor Application for University Minority Mentor Program 2009-2010

UFID (no dash):

Title (ex. Dr., Mr., Mrs):

First Name:

Last Name:

Have you served as a mentor before? Yes: No:

If you are a returning mentor, you can leave blank any area that does not need to be updated. Thank you!

Ethnicity:

Email:

Professional Information

College/Area:

Department/Unit:

Current Position:

Office Location:

Office Phone:

Other Phone:


Mailing Address:

Address:

City: State:

Zip:

Session you're applying for:

Current areas of specialization:

Undergraduate area(s) of study:

Three things you like to do in your spare time
1.
2.
3.

Three things that are important to you
1.
2.
3.

Is there anything else you would like potential mentees to know about you:

Is there information about the first year experience at UF you would like to be better informed about in order to enhance your effectiveness as a mentor:
Yes: No:
If yes, please check all that apply:
Academics Student organizations Support services Campus Life

Would you be interested in additional training about the needs of first generation in college minority undergraduate students?
Yes: No:
If so, would you prefer to receive this information in:
Live Presentation Emailed Resources

I plan to attend the Mentor Orientation on Tuesday, August 25, from 4:00-5:00 pm.
Yes: No:

I plan to attend the Match and Mingle to meet my mentees on Tuesday, August 25, 5:00-6:30 pm.
Yes: No:

By submitting this form the mentor agrees to the following statement:

"I understand that in signing up to participate in UMMP, I am making a serious commitment to open and regular commication with my mentee. If for any reason, I am unable to continue in this program, I will notify the Dean of Students Office in a timely manner so that my mentee can be reassigned."