FOCUS Mentoring Application for Students

1. Default Section

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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:

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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. 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

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* 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

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* 7. I am at my best in the:

Mornings

Afternoons

Evenings

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* 8. I consider myself to be:

Very Outgoing

Somewhat Outgoing

Somewhat Reserved

Very Reserved

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* 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

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* 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.

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* 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