HRCF Alumni Organization

Mentor Application Form

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Name
Email

May we contact you by email (event reminders, etc.)? Yes No

Contact Information (Home)

Address
City
State
Zip
Phone

Contact Information (Work/Campus)

Address
City
State
Zip
Phone

Other information

Gender
Marital Status
Mentee Preference (Gender)
If you were selected by a mentee outside of your preference, would you still be willing to mentor that student/alum?	Yes No
Would you be willing to discuss personal as well as professional issues?	Yes No
FAS Class Affiliation
Undergraduate Concentration
Undergraduate Christian Activity Affiliation

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)

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.

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:

Describe how you were blessed as an undergraduate:

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