Office of Multicultural Student Affairs | Mentoring | Undergraduate Mentee Application

Learn About OMSA

Undergraduate Mentee Application

Your information will be kept on file and we will contact you as soon as we find a suitable match. If you have any questions on the status of your application to the program, please contact Robin Graham. Thank you for your interest!

I. Personal Information

*First Name: *Last Name: *UCID#: Gender:

Male Female

Hometown: Are you a commuter student?

Yes No

*Campus Address (if you are a commuter student, please list your home address): *E-mail: *Phone: *Preferred Method of Contact:

Email Phone

Your ethnic background:

II. Other Personal Information (optional)

Hobbies/Interests: Religious Affiliation: Language fluency (other than English):

III. Your Academic Information

*Year in the college: Academic Major(s): Academic Minor (if applicable): College Adviser: What academic challenges do you anticipate for this year? *Have you already defined your professional interests/future goals?

Yes No

If so, tell us about your plans:

IV. Your Interest in the Chicago Multicultural Connection (CMC)

*What would you like to get out of this program (Please select all that apply)? *Would you prefer your CMC Mentor to be a

Graduate Student Staff/Faculty Member Alumnus No preference

*Would you prefer a mentor of the same ethnic background?

Yes No No preference

*Would you prefer a mentor of the same gender?