LEAP - Mentee Registration Form

If you see this don't fill out this input box.

*Full Name:

*In-School Address:

*City, State

ZIP:

Cell Phone:

*Email:

LinkedIn Profile:

Class Standing:

FreshmanSophomoreJuniorSenior

*Degree/Major:

Academy/High School:

Home State:

Gender:

MaleFemale

Ethnicity: Please Select Hispanic or Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White Other

Age:

Career goals after graduation:

Please check off any area in which you would like to be mentored.

Goals for Mentoring Relationship:

General SupportCareer Path ChoicesRealistic Job Preview (i.e. expected behaviorsskills in the workplace, 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)Spiritual DevelopmentRelocation Assistance (navigating a new area, finding a church, meeting new people)

Please Check off any area of interest from the list below.

Career:

Advertising | Creative MediaAccounting | FinanceAnimal Husbandry | VeterinaryBankingBusiness 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 ProductionMedicine | Dental | Allied | Health | Public HealthMusicNursingPastor | Religious LeadershipPerforming ArtsPhilanthropy | DevelopmentPhotographyPsychologyPublic RelationsPublishing | EditingRadio | TVRecreation | Travel | Sports | ManagementResearcher | ScientistSalesSocial Work | Social ServicesTechnical WritingVisual ArtsOther:

Values:

Achievement - ambitious, personal success through demonstrated competenceAuthority - respect for hierarchical power structureEnjoyment - pleasure, enjoying lifeEquality - equal opportunity for allHonesty - open and direct communicationMaturity - 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 Mentor: