NAME

Email

Program

Student Number

Year of study

Telephone Number

Address

1. What courses are you taking and which ones do you need help with?

2. List any club/organization that you are currently involved in.

3. What are your major interests and hobbies?

4. What are your possible career plans

5. Do you have any preference regarding the qualities of your mentor? (i.e. a commuter, program of study, etc.)

6. How would you like to get in touch with your mentor? (i.e. by email, phone face-to-face, etc.)

7. Any additional comments you would like us to take into consideration?