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Mentor Application

Mentor Application Form

All fields required. (Enter "N/A" if not applicable.)

Last Name


First Name


Preferred or Nickname


Address


City State Zip
      

Preferred Phone


Preferred Email


Confirm Email


Degree
in

Occupation


Employer


Career Field of Expertise


Number of Monthly Hours Available
We ask mentors for minimum 1 hour per month


List two professional references.
Please inform references they may be contacted about your participation.

Reference Name


Reference Phone


Reference Email


Reference Name


Reference Phone


Reference Email


Are you a Marylhurst student?
Yes       No

Are you a Marylhurst alum?
Yes       No

Are you the first in your family to graduate from Marylhurst?
Yes       No

Profile Information
Your profile information will be published in My Marylhurst, accessible to students, faculty and staff.

Job Description
e.g., I oversee career services and internships for a university.


Services I Can Provide
e.g., Career coaching and women's employment issues.


Hobbies
e.g., I practice yoga, love animals and the outdoors.


Proud/Recent Accomplishment
e.g., Raising loving children. Following my passions to teach and coach.


Goals & Ambitions
e.g., To assist people in achieving work/life balance.


Demographics - Optional
The following questions are optional. We appreciate your responses. They are reported as aggregate results when the Mentor Program seeks grants and other funding.

Gender
Male       Female

Age


Ethnicity

Questions? Contact the Program Coordinator.




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Marylhurst University
17600 Pacific Highway (Hwy 43) / PO Box 261 / Marylhurst, OR 97036-0261
Phone: 503.636.8141 / Toll-free: 800.634.9982 / Fax: 503.636.9526