Mentee Intake Form

Personal information: * Student Name

* Student Gender

Male

Female

Other

* Ethnicity. Check all that apply.

White

Black/African American

Hispanic

Latino/Latina

Native American/American Indian

Asian

Pacific Islander

Other

If you selected Other, please specify.

*Student CCSU Email

* CCSU Student ID Number

Questionnaire: * Current School Year
* What year are you? You must be a first year or sophomore next academic year to apply for a mentor.
* What is your major?

* What town do you consider home?

If you selected Outside Connecticut, please specify.

Languages, other than English, you are fluent in.

Spanish

Chinese

Tagalog

Vietnamese

Arabic

Other

If you selected Other, please specify.

* Did at least one of your legal guardians graduate from a four year college?

Yes

* Please select the hobbies/interests that apply to you. For best match, please select 5 hobbies.

* What are you most looking forward to experiencing in college?
* Why do you want a peer mentor?