Thank you for your interest in the Fontbonne University Council of Regents Mentoring Program. Please complete this application as a representation of your commitment to participate in the program. Also, by completing this application, you give the Mentoring Program coordinators permission to share this information with prospective mentors for the purpose of making a meaningful, appropriate match. 

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* 1. First Name

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* 2. Last Name

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* 3. Major (List Undecided if not declared.)

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* 4. Academic Year

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* 5. Preferred Email

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* 6. Preferred Phone

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* 7. Languages spoken

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* 8. I identify as a first-generation student. (Neither parent/guardian completed a 4-year degree.) Optional

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* 9. How did you hear about the program?

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* 10. Please tell us about your academic interests and career goals, if you know what they are. If you aren't sure, share what your current interests are.

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* 11. What are some of your hobbies/interests outside of school? What do you like to do for fun?

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* 12. Have you participated in a mentoring program in the past? If so, please describe your experience.

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* 13. Please tell us about your availability. "I will make myself available to meet with my mentor whether by email, phone, video chat, or in-person:"

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* 14. What modes of communication do you prefer to use with your mentor? Check all that apply.

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* 15. Is there anything else that you'd like us to know about you to best facilitate a good mentor/mentee match?

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* 16. If I am accepted as a participant in this program, I will have a responsibility to keep in regular contact with my Mentor e.g. by phone, email, Skype/Zoom, or in-person meetings.

If I decide to withdraw from the program, I agree to contact my Mentor and my Advisor immediately.

I agree that the Council of Regents Mentoring Program coordinators may use my photo for promotional purposes.

All information contained on this form is true and accurate.

First and Last Name

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* 17. Date

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