JC Mentor
New Mentor Application
Thank you for your interest in applying to the Johnson City Mentor Program. You MUST
complete ALL questions on this form in order to be considered.
The information you provide on this form will be shared with the Johnson City Middle
School Staff as they consider you as an applicant to mentor middle school students in
spring 2016.
As a new mentor applicant, in addition to this form you also need to submit your resume
to the “Johnson City Mentor First-Time Spring 2016" position on hireBING and you need
an employer or BU faculty or staff member to complete the reference form found on the
website. All three pieces of the application must be submitted by 11:59PM EST on the
application deadline.
Interviews will be held for those selected (you will receive an email asking you to
choose a time). Mandatory orientations for the program will be held in the evening of
interviews and later that week.
Registration for the mandatory writing intensive weekly seminar class will not occur until
after the interview day for those students who are selected to participate (you cannot
register yourself).
Binghamton's Fleishman Center staff manages the application process. If you have any
questions as you complete this form, please contact Lexie Avery at
jcmentor@binghamton.edu for assistance.
Please note that successful participation in this program requires you to have
access to a car, or be able to take the #17 bus from campus at 8am or 11am, and
return from JC school on the bus at 11:15am or 4:15pm. You MUST call the bus
company an hour before departure to let them know that you will need JC Middle
School Service.
Last Name_____________________
First Name___________________
1. What is your current class year at Binghamton University?
You have to have completed one year of college prior to applying to the JC
Mentor Program and this program is for undergraduate students only.
_____Rising Sophomore
_____Rising Junior
_____Rising Senior
2. What are your interests or hobbies?
JC School Staff use answers to this question to match you with a mentee who
has similar interests.
3. What, if any, other outside commitments or obligations do you have during
the semester? Examples include: part-time job, clubs, athletics, leadership
roles, etc...
4. Why are you interested in becoming a mentor to a middle school student?
What do you hope to accomplish in your mentoring relationship?
This is a short answer essay question. Please give the JC School Staff some
context about your interest and who you are as a person.
5. What is the most important advice that you could share with a mentee?
This is also a short answer essay question. Please write a paragraph or two
about advising you see middle school students needing that you feel
prepared/interested in providing.
6. Why are you an ideal candidate for this program?
In paragraph form, present a few experiences you have had and skills you
possess that prepare you to mentor a student.
7. I am aware that participation in the JC Mentor Program involves 5 hours in
the JC School each week and a 1-hour weekly seminar on BU's campus
and I can make that commitment to a Johnson City Middle School student.
If you select "No," you will not be considered an applicant for the program and
will not be selected to interview.
Yes
No
8. Do you need to petition to overload to participate in the JC program which
awards two internship credits?
If no, there is no further action you need to take. If yes, YOU MUST receive
approval from your College (Harpur, Watson, CCPA, SOM, Decker) before the
interview. If you are not approved you may not participate in the program.
Yes
No
9. Are you an international student?
If yes, you may need to apply for a CPT. Please speak to ISSS to process any
necessary paperwork prior to 2/6/14.
Yes
No
10. I understand that the hours at the JC Middle School are generally 7:30 am2:15 pm and that I must complete the five hours per week during this time.
If you select "No" you will not be selected to interview.
Yes
No
11. What is the name of the employer or BU staff/faculty member who has
agreed to provide your reference form for the JC Mentor Program?
12. What is the email of the employer or BU staff or faculty member who you've
asked to complete your reference form?
13. What is the phone number of the BU staff or faculty member who has
agreed to provide your reference form for the JC Mentor Program?