If you have any questions regarding this application form or the Mentor Program, please contact firstname.lastname@example.org.
Mentor Contact Information
Address Line 2
How would you prefer to be contacted by your mentee? (Please select all that apply.)
Video Call (Skype)
How many students would you be willing to mentor?
Three or more
Your Degree(s) and College/University
Please describe your role and responsibilities in your current position.
Please list any profesional fields related to your current position or background:
Describe the activities, interests and/or hobbies that are most meaningful to you:
Please describe any other relevant information you believe we should know to aid in the pairing process (Optional):
List any Chapman University affiliations (Optional):
Please attach a recent resume to assist in the pairing process. (Optional)