PASS Mentor Program * Dean of Students Office Bloomsburg University KUB 101 * (570) 389-4734 Mentee Profile: Please complete the following information and send the profile back to email@example.com or the Dean of Students Office. 1. Name: Student ID: Email address: 2. Year at Bloomsburg University: 1 2 3 Best method of Contact: 4 5+ Grad 2 b. Most recent number of credits earned: 3. Major of Study: 4. Extracurricular Activities/Hobbies: 5. Would you prefer a male or a female mentor? Male Female No Preference 6. How often would you like to meet with your mentor? Weekly Monthly Bi-weekly As Needed 7. What topics would you be willing to discuss with a mentor: Academics Fitness/Wellness Relationship Issues Alcohol/Drugs Getting Involved Decision Making Religion Sports Homesickness Financial Care Other: Academic Skills Fitting In Adjustment Roommate Issues Parental Involvement Social Skills Career Development 8. Would you be willing to meet for one-hour group workshops/discussions in the evenings? (i.e. study skills workshop, relaxing before finals, etc) Yes No Maybe 8a. If yes, what workshops topics would you be interested in? (Please Circle) Study Skills Sporting Events Stress Relaxation General College Management Budgeting/Money Management Other: B the best U at BU!