MSLI Mentor Information Form

Name

Home/Permanent Address

Address

City/Town

State/Province

ZIP/Postal Code

Country

Daytime/work phone

Cell phone

College

Grad Year

Major/Minor

Graduate Degree from

Year

Discipline

Company

Company Address

Title

Industry

Please upload your resume here:

Please upload your resume here

One file only.
256 MB limit.
Allowed types: txt, rtf, html, pdf, doc, docx, ppt, pptx, xls, xlsx, xml.

What industry are you most interested in mentoring?

Briefly summarize your goals as a mentor.

What is your expectation for the MSLI Mentoring relationship?

Please list your favorite hobbies.

What is your weekly availability?

How often are you willing to meet?

What type of relationship would you like to have with a student?

In the attributes listed below, I would rate myself predominantly

Please select one option in each list:

Attribute 1

Attribute 2

Would you be willing to include a student in your work activities, such as shadowing, attending a meeting, etc.? Please list.

Are you most comfortable communicating via:

Please check all that apply; and note that the preferred goal is minimally three face-to-face meetings for the 15-week period.

Phone

Skype, FaceTime or other

In person

Would you be willing or interested in mentoring a student with a disability?

Would you prefer to mentor a specific ethnicity or trait?

If yes, please specify

Which of the following aspects of mentoring most interests you?

Please rate on a scale of 1-5.

Offering career advice, support and guidance

Providing general life and soft skills support

Moral support and encouragement

Sponsorship and/or long term relationship with student

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MSLI Mentor Information Form

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