PASS Mentor Program * Dean of Students Office
Bloomsburg University * (570) 389-4734
Mentor Profile: Please complete the following information on both pages and submit to
deanofstudents@bloomu.edu or drop it off at the Dean of Students Office KUB 101. Question 9
is an essay question and should be completed as thoroughly as possible.
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 mentee?
Male
Female
No Preference
6. How often would you like to meet with your mentee?
-Weekly
- Monthly
-Bi-weekly
- As Needed
7. What topics would you be willing to discuss with a mentee:
Academics
Fitness/Wellness
Relationship Issues
Alcohol/Drugs
Getting Involved
Decision Making
Religion
Sports
Homesickness
Financial Care
Other:
Academics
Fitting In
Adjustment
Roommate Issues
Parental Involvement
Social Skills
Career Skills
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:
Dean of Students Office* Bloomsburg University of Pennsylvania* 570-389-4734
B the best U at BU!
PASS Mentor Program * Dean of Students Office
Bloomsburg University * (570) 389-4734
9. Why do you want to be a mentor? (Please complete answer on space available or on a separate
piece of paper)
Dean of Students Office* Bloomsburg University of Pennsylvania* 570-389-4734
B the best U at BU!