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El Paso Community College
Student Mentoring Program
Mentor Application
Contact Information:
Name: _________________________________________________________
EPCC Office Location: ____________________________________________
Department: _____________________________________________________
Phone# (Campus): ________________________________________________
Phone# (Off Campus): _____________________________________________
Email: __________________________________________________________
Mentor ID: _______________________________________________________
Gender
Male
Female
Volunteer Information:
1. Initial on the lines provided:
_____ I agree to attend one or more training sessions.
_____ I agree to contact the mentee during the following: beginning of semester, midpoint, and
the end of the semester (e-mail, phone, or on college property)
2. What days of the week are you available to participate? (check all that apply):
O Monday
O Tuesday
O Wednesday
O Thursday
O Friday
3. What is the best time for you to participate? (check all that apply):
O Mornings
O Afternoons
O Evenings
4. What are your hobbies and interests?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Circle any of the words below that you think describe your personality:
Quiet
Withdrawn
Friendly
Shy
Outgoing
Insecure
Nervous
Talkative
Inquisitive
______________________________________
Signature
Adventuresome Sensitive
Confident
Happy
Spiritual
Moody
_____________________
Date
Revised on 2/28/12
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