Name:                Male     Female             

UD ID #: * required field         Race/Ethnicity:
           

Summer Mailing Address:
Street:  

City:  State:   Zip:

Home phone:   Cell phone:

Campus phone:      UD e-mail:   * required field

Major:       Classification: (as of Fall 09)

Cum. GPA:

Have you participated in the EORO program before?  YES   NO
If yes, please check all that apply:   Mentee               Mentor          Mentor Coordinator.

Pleased describe any previous mentoring experience:

Are you currently employed?                       YES                    NO

If yes, how many hours a week?      

Please list the campus activities and organizations that you are involved in:

Briefly, describe your background, personal interests and hobbies/interests outside of the University of Delaware.  Also, discuss your expectation of the mentor experience.

.Please check all the skills that you would be able to give your mentee:

Academic Support     Time Management       Social Support      Campus Resource
Other (Special Skill)  
                                         (please specify)

I am willing to mentor two students.                    YES               NO

Please rank your preferences for mentee selection:

Male   Female      Same Major    Same Hobbies 
Same Hometown     Other(s):     No Preference

I agree, if accepted as an Each One Reach One Mentor, to assume the role of a mentor to the best of my ability. I will be committed to encouraging personal growth in my mentee and strengthening community with my participation in campus activities. Furthermore I permit the Center for Black Culture to gather information regarding my academic progress.

 I  AGREE                 Date

Mentor Training Date - TBA