FOCUS Mentoring Application for Students Survey

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* 1. Please complete the following:

First/Given name:

Last/Family name:

Major:

Minor:

Birthday:

Year in School this fall:

CLU Email:

Other Email:

Cell Phone:

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* 2. What is your gender?

Female

Male

Other (please specify)

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* 3. Race/Ethnicity:

Asian/Asian American

American Indian

Black/African American

Hispanic/Latin American

Multi-Racial

Pacific Islander

International Student

Other

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* 4. If you selected International Student or Other for the previous question please indicate what country you are from or what race/ethnicity you identify as:

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* 5. Cal Lutheran welcomes students of all faith traditions. How would you describe your religious beliefs today?

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* 6. I plan to live:

On Campus in Mt. Clef Residence Hall

On Campus in Pederson Residence Hall

On Campus in Thompson Residence Hall

On Campus in an Old West Residence Hall

On Campus in a New West Residence Hall

On Campus in Grace Residence Hall

On Campus in Mogan Residence Hall

On Campus in Trinity Residence Hall

On Campus alternate housing

Off Campus

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* 7. Please rate your academic skills:

	Excellent	Pretty Good	Okay	Need Some Help
Math Skills:	Math Skills: Excellent	Math Skills: Pretty Good	Math Skills: Okay	Math Skills: Need Some Help
Written Communication Skills:	Written Communication Skills: Excellent	Written Communication Skills: Pretty Good	Written Communication Skills: Okay	Written Communication Skills: Need Some Help
Oral Communication Skills:	Oral Communication Skills: Excellent	Oral Communication Skills: Pretty Good	Oral Communication Skills: Okay	Oral Communication Skills: Need Some Help
Reading Skills:	Reading Skills: Excellent	Reading Skills: Pretty Good	Reading Skills: Okay	Reading Skills: Need Some Help

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* 8. I am at my best in the:

Mornings

Afternoons

Evenings

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* 9. I consider myself to be:

Very Outgoing

Somewhat Outgoing

Neutral

Somewhat Reserved

Very Reserved

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* 10. Extracurricular activities you plan to be involved in: (check all that apply)

Sport(s) team

Faculty sponsored research

Music or dance performance

Student Newspaper (ECHO)

Creative writing & artwork

Student government leadership

Political Activism

Theatre Production

Clubs & organizations

Community service volunteer

Campus Ministries/Community Church

Study abroad

Job or internship

Interfaith movement

Social justice work

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* 11. Please comment on how you enjoy spending your free time, anything you are concerned about, or anything you would like your mentor to know about you.

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* 12. RSVP for dinner on Wednesday, September 5th at 5pm-6pm.
Attendance is required in order to establish a good mentoring relationship!

Not sure because of other commitments.

Yes, I will attend

No, I am unable to attend

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* 13. Which is most important to you?

To have a mentor from a similar ethnic background

To have a mentor with a similar academic major

To have a mentor with similar extracurricular interests

None of this matters to me

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* 14. What is the best way for your mentor to contact you?

Email (Cal Lutheran email account only allowable)

Text message

Phone call

Other (please specify)

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* 1. Please complete the following:

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* 2. What is your gender?

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* 3. Race/Ethnicity:

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* 4. If you selected International Student or Other for the previous question please indicate what country you are from or what race/ethnicity you identify as:

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* 5. Cal Lutheran welcomes students of all faith traditions. How would you describe your religious beliefs today?

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* 6. I plan to live:

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* 7. Please rate your academic skills:

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* 8. I am at my best in the:

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* 9. I consider myself to be:

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* 10. Extracurricular activities you plan to be involved in: (check all that apply)

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* 11. Please comment on how you enjoy spending your free time, anything you are concerned about, or anything you would like your mentor to know about you.

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* 12. RSVP for dinner on Wednesday, September 5th at 5pm-6pm. Attendance is required in order to establish a good mentoring relationship!

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* 13. Which is most important to you?

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* 14. What is the best way for your mentor to contact you?

* 12. RSVP for dinner on Wednesday, September 5th at 5pm-6pm.
Attendance is required in order to establish a good mentoring relationship!