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Mentorship Committee

IACAC Mentorship Program Application

I would like to be a
Mentor (suggested 5+ years of experience)
  Mentee (less than 5 years of experience)
  Counselor Crony
   
Name: 
E-mail:
School/College/Agency: 
Mailing Address: 
City: 
State: 
Zip: 
Work Phone: 
Cell Phone: 

Years of Related Experience:

Your answers to the following questions will be used to determine the best match for you in the mentorship program.

In the past I have been a:
  Mentor
  Mentee 
  Both
  Neither
   
I would like a mentor/mentee from:
  High school
  College
  Either one is fine
  Other, specify:
      
   
Within the state, I would prefer a mentor from:
  No Preference
  Chicago area
  Northwest
  Central
  South
Describe your present position (check all that apply):

College Applicants:

Transfer Coordinator
Minority Recruitment Coordinator
Athletic Liaison/Coordinator
On-campus visit coordinator
Publication coordinator
Student Worker Supervisor
Other, specify:

High School Applicants:

Department Chair
College Counselor
Guidance Counselor
Other, specify:

Tell us a little about your personality and your interests:

What traits/characteristics would be most important to you in a Mentor, Mentee, or Crony?

P.S.  When is your birthday?

  Omit the year if you like!  

 

 

 

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