Center for Multicultural Education

Programs and Trainingsmichend2019-05-17T10:58:25-05:00

STUDENTS OF COLOR ORIENTATION MENTEE APPLICATION

Name*
First Last
G Number*
Local Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Hometown (city & state)*
Cell Phone Number*
Year in School*
- Freshmen
- Sophomore
- Junior
- Senior
Major and/or Minor*
Gender Identity*
Pronouns (example: She/Her/Hers, He/Him/His, Them/They/Theirs)*
Missouri Western Email*
Languages Spoken*
Are you a first generation college student?*
Do you have a gender preference for your mentor? If yes, what is your preference.*
Racial/Ethnic Identity*
Check all that apply. If you are not satisfied with the standard categories that reflect race/ethnic identity please check other and identify the racial/ethnic identity you choose to be identified by.
- Asian
- Black or African American
- Hispanic/Latino
- Native American or Alaska Native
- Native Hawaiian
- White
- Other
Personal Traits and Characteristics*
Check all that apply
- Acting/Plays
- Arts/Crafts
- Community Service/Volunteering
- Dance
- Fashion
- Hiking/Seeing Nature
- Movies
- Music
- Photography
- Politics
- Reading
- Singing
- Sports
- Television
- Video Games
- Visit Parks/Museums
- Working Out
- Writing/Poetry
- Other
Please list any hobbies or interests you have*
What qualities would you like in a mentor?*
What individual has served as a role model to you and why?*
What do you hope to gain from your participation in the Mentoring Program?*
Which of these activities would you participate in with your mentor?*
Check all that apply
- Athletic Events
- Community Service
- Cultural Events
- MWSU Events & Activities
- St. Joseph Community Events
- Study Groups
- Tutoring
- Others
How important is similar matching?*
Very Important Moderately Important Unimportant
Gender
Major
Areas of Interest
Personality Charateristics
Please list any additional information that would be helpful in the mentor/mentee pairing process.

	Very Important	Moderately Important	Unimportant
Gender
Major
Areas of Interest
Personality Charateristics