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Mentor Sign Up Form
Required fields are marked with an asterisk (*).
First Name
Last Name
Preferred Pronouns
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Declared Pre-Major or Major and Minor (if applicable)
What is your anticipated graduation year and quarter?
In which ways are you comfortable contributing to this program?
As a role model, serving students with similar identities to my own
With professional development
With greater social connection to the CBE
With general guidance, support, and encouragement
Other…
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If you would prefer to act as a role model to students with similar identities to you, please select the identities that you are comfortable with.
Race
Cultural identity
Gender expression
Sexual orientation
Ability
Neurodivergence
Other…
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What is one piece of advice or insight that you have received from a mentor that sticks with you today? Briefly explain (2-4 sentences).
How many students do you have capacity to mentor?
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One
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Three
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