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Mentee Profile Application form
     
     
 
*First Name:
Middle Name:
*Last Name:
Preferred Name:
 
 
  
 
*Student ID Number:
*Major:
Minor (if applicable):
Today's Date
 
 
 
    
MM/DD/YYYY
  
 
Junior Senior
Graduate Other
 
 
 
  
 
Expected Graduation Date:        Semester:
Fall
 Year:  
 
Spring
i.e. 20XX
  
 
Summer    
 
 
 
*Contact Phone:
*E-mail:
Other E-mail:
 
 
 
  
 
*Campus Address
  
 
Street:
City:
State:
Zip Code:
  
 
 
 
Permanent Address
  
 
Street:
City:
State:
Zip Code:
  
 
 
  
 

*Industry Preference after Graduation:

*Job Preference after Graduation:  
  
 
 1
2
3
 
 
 
 

1.*What are your goals for the first three years after graduation?

2.*What do you think your biggest challenges will be during the first three years after graduation?
 
 
 
  
 
3.*What do you hope to gain from the RCOB Mentorship Program?
4.*Briefly summarize your previous work experience.
 
 
 
  
 
*Please Indicate here(check all that apply) the mentoring activities in which you would like to participate.
(Note: Activities you indicate may or may not be available based on your assigned mentor's preferences.
 
 

e-mail

Phone

In-Person

Internship
 
 
Shadow
Lunch
Other
 
     
 
 
 
 
 
*I have read understand the Terms and Conditions of the Program
  
 
       
 
*Required Fields
  
     
 
 
 
 
  
E-Mail | Phone: (678) 839-6467 | Fax: (678) 839-5040