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WKCTC Mentor Application
Chances are someone along your path gave you that extra attention, push needed, incentive, or inspiration to reach the goals you have achieved.  Now is your chance to give back and become a mentor for a student.  Complete the form below to show your interest in being a mentor. The fields required are denoted by an asterisk (*). 
Contact Details
*Today's Date                            
format mm/dd/yyyy 
 
    
*First Name               
*Last Name                             
*Division/Department           
*Position                    
*School Phone Extension(5 digits)                          
Alternate Phone Number        
 
format xxx-xxx-xxxx
                              
*Email Address          
Mentoring Information
How many students are you willing to mentor?   
  
Check preferences of type of student you are willing to mentor (Check all that apply)     
               
If you are part of a specific grant program or you are located at an off-campus site, these would impact the students selected for you to mentor.  Please specify any limitations.  
 
What are your academic areas of expertise and interest? 
      
What are some hobbies, sports, or leisure activities that you enjoy?        
   
What are some ways you can help your mentees reach their college goals?
Please write a short paragraph introducing yourself to your mentee.
Please read the Mentor Contract Agreement.

Please read and initial the statement below (2 initials only)
I have read and agree to the mentor contract.