Skip Navigation Links
WKCTC Mentee Application
Complete the application form below to show your interest in being mentored. The fields required are denoted by an asterisk (*). 
Contact Details
*Today's Date                            
format mm/dd/yyyy 
 
    
*KCTCS Student ID#      
*First Name               
*Last Name                             
*Address           
*City                    
*State                          
*Zip                             
*KCTCS Email Address          
Personal Email Address          
*Preferred Phone Number        
 
format xxx-xxx-xxxx
          
Other Phone Number        
 
format xxx-xxx-xxxx
          
Mentoring Information
If you wish to request a specific WKCTC mentor, please enter first and last name below.
What is your major; or if undecided, what careers are you considering?
What are some of your interests and hobbies? (sports, computers, music, academic subjects, etc.)
You will need to meet with your mentor on a regular basis during daytime hours.  What time of day is best for you?
Please select all areas below for which you need assistance.
                                
    
If you checked "other" above, please describe. 
Please write a short paragraph introducing yourself to your new mentor.