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Mentee Application Form
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Name
Email
May we contact you by email (event reminders, etc.)?
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Mentor Choices
First Choice
Second Choice
Contact Information (Home)
Address
City
State
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
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NJ
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OK
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PR
PW
RI
SC
SD
TN
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VI
VT
WA
WI
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Zip
Phone
Contact Information (Work/Campus)
Address
City
State
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip
Phone
Other information
Gender
Female
Male
Marital Status
Single
Engaged
Married
Single Again
Mentor Preference (Gender)
Female
Male
Either
FAS Class Affiliation
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
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1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
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1965
1964
1963
1962
1961
1960
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1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
Undergraduate Concentration
African American Studies
African Studies
Anthropology
Applied Mathematics
Archaeology
Astronomy and Astrophysics
Biochemical Sciences
Biological Anthropology
Biology
Chemistry
Chemistry and Physics
Classics
Computer Science
Earth and Planetary Sciences
East Asian Studies
Economics
Engineering Sciences
English and American Literature and Language
Environmental Science and Public Policy
Film Studies
Folklore and Mythology
Germanic Languages and Literatures
Government
History
History and Literature
History and Science
History of Art and Architecture
Linguistics
Literature
Mathematics
Mind, Brain, and Behavior
Music
Near Eastern Languages and Civilizations
Philosophy
Physics
Psychology
Religion, Comparative Study of
Romance Languages and Literatures
Sanskrit and Indian Studies
Slavic Languages and Literatures
Social Anthropology
Social Studies
Sociology
Special Concentrations
Statistics
Visual and Environmental Studies
Other
Undergraduate Christian Activity Affiliation
Harvard Radcliffe Christian Fellowship
Harvard Radcliffe Asian American Christian Fellowship
Asian Baptist Student Koinonia
Catholic Students Association
Harvard Radcliffe Christian Impact
Reformed Christian Fellowship
Orthodox Christian Fellowship
Other
None
Other Undergraduate Clubs, Activities or Affiliations:
Graduate School Affiliation (if any)
Graduate School
Year
Graduate School
Year
Graduate School
Year
Career Information
Profession
Specialty
What best categorizes your field of interest? (select up to three)
Academic Administration
Business
Communications
Education K-12
Finance
Healthcare Management
Higher Education
Law
Medicine
Mental Health
Ministry
Non-Profit
Public Health
Public Policy/Government
Publishing
Research
Science
Social Services
Special Education
Technology
Writing/Film Art
Academic Administration
Business
Communications
Education K-12
Finance
Healthcare Management
Higher Education
Law
Medicine
Mental Health
Ministry
Non-Profit
Public Health
Public Policy/Government
Publishing
Research
Science
Social Services
Special Education
Technology
Writing/Film Art
Academic Administration
Business
Communications
Education K-12
Finance
Healthcare Management
Higher Education
Law
Medicine
Mental Health
Ministry
Non-Profit
Public Health
Public Policy/Government
Publishing
Research
Science
Social Services
Special Education
Technology
Writing/Film Art
Please answer the following questions completely. Your answer to each question should be between 100-125 words in length.
Please describe your particular career interests or fields that you would like to explore. Please be specific.
What are your expectations for this mentorship? Your answers will help you and your mentor develop a good and satisfying relationship.
How important is it for you to be able to talk about personal (i.e. career and family/personal life balance) as well as professional issues with your mentor? What kind of issues are most important to explore?
Briefly answer the following:
How would you like to primarily communicate with your mentor? (E-mail, phone, in person). If in person, how frequently, and at what times, would you be able to meet with your mentor? What, if any, scheduling constraints do you foresee? Would you like to meet during the academic year, the summer or both?
Please choose the option below which best describes how often you anticipate meeting or communicating with your mentor through email or phone calls during the upcoming year. This will serve as a guide for the mentor's expectations for the mentor's time commitment.
Two or more in-person meetings per semester; phone call or email once per month
One in-person meeting per semester; phone call or email every other month
Zero to one in-person meetings per year; phone calls or emails on as-needed basis
Would you like to visit your mentor's workplace?
Yes
No
Would you like to visit your mentor's home?
Yes
No
What are the best times for you to meet? Indicate the times you prefer:
Weekday Morning
Weekday Afternoon
Weekday Evening
Weekend Morning
Weekend Afternoon
Weekend Evening
Please indicate any specific requests or requirements you may have regarding your involvement in the program (i.e. limited hours available, available only during working hours):
Please describe your job (if applicable). Be as specific as you can; include title, areas of expertise, and describe your work environment. (Please use additional paper, if necessary.)
Describe any pertinent information about your career and job history (if applicable).
Describe any special interests you would like to share. For example: family life; ethnic, cultural, social, athletic, artistic, philosophical, religious, and political interests; hobbies; volunteer activities or other).
Describe how you became a Christian and the status of your relationship with Jesus Christ and His Church:
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