LEAP - Mentor Registration

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*Full Name:

Address:

City, State:

ZIP:

Home Phone:

Cell Phone:

Work Phone:

*Email:

LinkedIn Profile:

Years Attended/Preferred Class Year:

Degree/Major:

Academy/High School:

Home State:

Graduate School:

Degree:

Ethnicity:

Hispanic or LatinoAmerican Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Pacific IslanderWhiteOther

Current/Former Job Title:

Company:

Company Website:

Goals for Mentoring Relationship:

General SupportCareer Path Choices (education requirements, recommended job-related experiences, physical & behavioral health expectations)Realistic Job Preview (typical duties, jobs pros and cons)Finding Internship (not to be the responsibility of mentors; an area of assistance)Personal Skills (self-confidence, time management, cultural awareness, goal-setting)Financial Planning (budgeting, investment)Spiritual DevelopmentRelocation Assistance (navigating a new area, finding a church, meeting new people)

Please check off an area of interest from the list below

Career:

Advertising | Creative MediaAccounting | FinanceAnimal Husbandry | VeterinaryBankingBusinessBusiness ManagementComputer Software | Hardware Design and DevelopmentCounselingCulinary ArtsEducation | TeachingEnglishEntrepreneurshipEnvironment Environmental ProtectionFilm | AnimationGovernment | MilitaryGraphic DesignHealthcare AdministrationHistoryHuman ResourcesIndustrial Technology | Construction ManagementInformation Management Information TechnologyInternational BusinessInternational ServiceInternet | Website Design and DevelopmentJournalismLawLaw EnforcementLibrary and Information SciencePoliticsLong-Term Care AdministrationMarketing | Market ResearchMedia ProcuctionMedicine | Dental | Allied Health | Public HealthMusicNursingPastor | Religious LeadershipPerforming ArtsPhilanthropy | DevelopementPhotographyPsychologyPublic RelationsPublishing | EditingRadioTVRecreation | Travel | Sports ManagementResearcher | ScientistSalesSocial Work | Social ServiceTechnical Writing Visual ArtsOther:

Please check off three (3) values that are most important to you

Values:

Achievement - ambitious, personal success through demonstrated competenceAuthority - respect for hierarchal power structureEnjoyment - pleasure, enjoying lifeEquality - equal opportunity for allMaturity - appreciation, understanding, and acceptance of oneself, others, and the surrounding worldRespect for Tradition - preservation of time-honored customsSelf-direction - independent thought and action-choosing, creating, exploringVariety in Life - challenge, novelty, and change

Interests | Hobbies:

Personal Statement to Mentee: