Exit this survey FOCUS Mentoring Application for Students 1. Default Section Question Title * 1. Please complete the following: First/Given name: Last/Family name: Major: Minor: Birthday: Year in School this fall: CLU Email: Other Email: Question Title * 2. What is your gender? Female Male Other (please specify) Question Title * 3. Race/Ethnicity: Asian/Asian American American Indian Black/African American Hispanic/Latin American Multi-Racial Pacific Islander International Student Other Question Title * 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: Question Title * 5. 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 Off Campus Question Title * 6. 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 Question Title * 7. I am at my best in the: Mornings Afternoons Evenings Question Title * 8. I consider myself to be: Very Outgoing Somewhat Outgoing Somewhat Reserved Very Reserved Question Title * 9. Extracurricular activities you plan to be involved in: Sport(s) team Music program Student Newspaper (ECHO) Creative writing & artwork Student leadership Political Activism Theatre Production Clubs & organizations Community service volunteer Campus Ministries/Community Church Study abroad Job Question Title * 10. 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. Question Title * 11. RSVP for dinner on a Wednesday in early September. Attendance is mandatory in order to establish a good mentoring relationship! Not sure because of other commitments. Yes, I will attend No, I am unable to attend Done