Mentor 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 junior or senior next academic year to be a peer 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.

* Why would you make a good mentor to first years and sophomores?

* What are the requirements to being a good mentor to someone who may have a different background than you?

* Describe a time when you encountered a challenge in college, and how you dealt with it.

* What does it take for a first generation college student to be successful?