Mentor Application

Office of Diversity, Equity and Inclusion

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STRIVE Mentorship Mentor Application

Personal information

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Gender identity *

Preferred gender pronoun *

Preferred method of contact *

phone
email

Employment information

Employer name *

Job title *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Work contact email *

Work contact phone *

Career field

What is your preferred communication style?

Direct and to the point: Someone who will push you and be honest
Honest with a soft approach: Someone who will be honest and suppoortive at the same time. Lead you in the right direciton and give a soft push, but not push too hard.
Coaching: Someone who has a collaborative approach to feedback and will explore all avenues until you both agree.

Electronic signature *

By signing this application, you acknowledge that you are applying for a voluntary commitment to mentor a student. For any Non-St. Clair Community County College faculty or staff, a background check will be required.

Type your full legal name in the box provided as an electronic signature for this Application for STRIVE Mentorship Mentor Application.

Date *

Motivation Success Coaching Goal and direction illustration with gears

Office of Diversity, Equity and Inclusion

STRIVE Mentorship Mentor Application

Personal information

Employment information

Career field

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