Mentor Program: Student Application

Please note: When filling out the sections below with text boxes, please consider that the Mentor will be selecting you based on information you provide here, not just your major. I encourage you to be very thorough in providing information about what you have done and what you are interested in finding out about from a Mentor. It cannot be guaranteed that you will have a Mentor that fits or can do EVERYTHING, however they will have a clear understanding of what you are looking for and how they may be able to assist you. Have more questions? Please contact Jonika Moore-Diggs at moorej3@xavier.edu to schedule a Mentoring Program Information Meeting prior to completing the application.

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Required fields are in bold.

Personal Information First Name
Last Name
Gender Male Female
Xavier Email
Phone
Hometown (City, ST)
High School

Local Address

Please enter your local/current address.

Street

City
State
Zip Code

Permanent Address

Please enter your permanent address, if different than your local address.

Street

City
State
Zip Code

Academic Information Class Year
Major 1
Major 2
Minor

Extracurricular Activities

Please list your involvement in the following (current or previous):

Student Organizations
Athletics
Volunteer/Other Interests

Mentor Preference Information

Please check all that apply:

General Life Advice
Resume / cover letter help
Job Shadowing
Internships
Practice Interviews
Networking
Graduate school assistance

Additional Information

I am a (check all that apply, optional):

TRiO - Student Support Services student
International student
Student with disabilities
First generation student
Adult/Part-time student

My ethnicity(ies) is/are (check all that apply, optional):

American Indian/Alaskan Native
American Indian/Alaskan Native
Black or African American
Hispanic
White

Please check all that apply:

I would like to have a mentor from the greater Cincinnati area
I prefer to have a mentor outside the greater Cincinnati area
I have a clear career path and personal goals
I am still exploring different career paths
I would like general coaching about life after graduation
I would like information on and assistance with graduate school applications
I would like information on and assistance with resumes and job interviews
I am interested in other opportunities to network with and learn from alumni - including career presentations and mock interviews

Describe any career related experiences you have had (i.e. internship, job shadowing, professional organization, etc.)

What do you hope to gain from the Mentor Program?

This section should be used to inform potential mentors about your career and academic goals (or your need to establish them); industry/career areas of interest (or lack thereof) and/or how you believe a mentor might be able to assist you in the development process. Please keep in mind being too specific ("I want a neonatologist as opposed to a doctor who may have experience in that area but I am open to explore other options") or too vague ("I want any assistance anyone can give me") can both prevent a potential mentor from identifying different ways they can be of assistance to you.

Resume
*file must be a pdf or Microsoft Word document

How did you learn about the Xavier University Mentor Program?

Career Services Staff
Student
Faculty/Staff
Presentation
Other

If you have attended a university sponsored event and met a potential mentor, please provide his or her name and contact information below. We will follow up with them and encourage them to join the program.

I understand this program is driven by my level of need and requires contacting my mentor monthly.
I understand that I will notify my mentor and the program coordinator should I decide to no longer continue in this program.