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Mentor/Mentee Application Form
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Mentor/Mentee Application Form
*
denotes a required field
Group Affiliation:
*
Choose one
Allies Mentoring Program
LCAHRM Mentoring Program
IT Mentoring Program
Color of Teaching Mentoring Program
Lancaster Partnership Mentoring Program
MCM/MCW Mentoring Program
Millersville Scholars Mentoring Program
Penn Manor/MU Mentoring Program
Millersville Mentoring Alliance Program
Peer Health/Peer Educator Mentoring Program
Other/Not Sure
Provide Affiliation Name:
*
Contact & Applicant Information
Name:
*
Millersville ID#:
(If Applicable)
Local Address:
*
City:
*
State:
*
Zip:
*
Preferred Phone:
*
Alt. Phone:
Preferred Email:
*
Alt. Email:
Gender:
*
Male
Female
Ethnicity:
African-American
Asian/Pacific Islander
Hispanic
Caucasian
Other
Mentor/Mentee Information
I am applying to become a
Mentor
Mentee
Both
Other/Not sure
*
Mentor Information
Mentor Type:
*
Faculty/Staff
MU Alumni
Community
Peer Mentor
Company:
Title:
Department:
Mentee Information
Class level:
*
Freshmen
Sophomore
Junior
Senior
Major(s):
Minor(s):
What are you looking for in a mentoring partnership?
*
Tell us about your career or your academic goals.
*
What are some of your personal interests/hobbies/experiences?
*
How did you hear about the MMAP?
*
If you know with whom you'd like to be matched, provide name.
Additional Comments:
Submit Application
