WINGS Mentor Application Name (First and Last) Date of Birth: Phone: Email: Current Position/Title: College/School or Department Unit: What degree prgram(s) was your undergraduate or post graduate degree(s) in? When is a good time for you to participate in WINGS? please provide your availability What are your Hobbies/Interest : Demographic Information Demographic information is collected statistical and potential matching purposes. For example, if a student requests a mentor of their same gender for cultural reasons, we will use this information to match them in some of these cases. I identify my gender as: (i.e. Male, Female,Transgender.etc) I identify my sexual orientation as: (i.e. Bisexual, Gay, Lesbian,Straight, Queer,.etc) I identify my identity as: White/Caucasian Hispanic Latino/a African or African American Asian or Asian American Native Hawaiian or Pacific Islander Native American or Alaskan Native Middle Eastern Multi ethnic/racial other (Check all that apply) Please indicate up to 3 of your most important matching preference(s) based on the following,if any? Gender Race Ethnicity Sexual Orientation Interests Major/College Career What special talents, skill, or experiences do you have that would assist us with matching you with a future mentee? What made you decide to participate in this progarm? How many mentees can you commit to mentoring during the 2015-2016 academic year?* Is there anything else you would like potential mentee to know about you? This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
