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
deanofstudents@bloomu.edu 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:
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