Office of Multicultural Student Affairs | Mentorship | Mentor Application for Staff/Faculty/Alumni

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Mentor Application for Staff/Faculty/Alumni

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: Gender:

Male Female

*University of Chicago Affiliation:

Faculty Staff Alumnus

*Mailing address: *E-mail: *Phone: *Preferred Method of Contact:

Email Phone

Your ethnic background:

II.Please fill this section if you are a faculty or staff member.
Alumni should skip to Section III.

University of Chicago Department: Your Position: Please describe your job responsibilities at the University of Chicago: Campus Location:

III. Please fill this out if you are a University of Chicago alumnus.
Faculty and staff should skip to Section IV.

University of Chicago Degree Completed (please select all that apply): Year(s) of Graduation: University of Chicago School/Division (please select all that apply): Department/Specialty (if applicable): Current title and company/organization name (e.g. Teacher, Chicago Public Schools; Consultant, Bain & Company; Harper-Schmidt Post-doctoral Fellow, University of Chicago): Brief description of your job:

IV. Other Personal Information (optional)

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

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

*Why are you interested in being a CMC mentor? *How would you define effective mentorship? *How will you contribute to the CMC? *What will you gain from this experience? Is there anything else we should keep in mind while selecting your mentee? Do you have any suggestions for events/programs (ie. workshops, social events, outings)?

Office of Multicultural Student Affairs at The University of Chicago