Mentor Program Application

NORTHERN KENTUCKY UNIVERSITY
OFFICE OF LATINO STUDENT AFFAIRS
MENTOR PROGRAM APPLICATION

The purpose of the Latino Student Mentor Program is to promote and enhance the retention and academic success of entering Latino students.

Date
Name
Permanent Address	Street Apt# (if applicable) City, State Zip
Phone
Temporary Address	Street Apt# (if applicable) City, State Zip
Phone
Major
GPA
Classification Status
Employment
Employment Address	Street Apt# (if applicable) City, State Zip
Phone number where you will most likely be reached
Best time to call

Please respond to the following questions:

	Are you involved in other organizations (campus or community)? Please list organizations and the roles you play.

	In an essay form, please explain why you would like to be a Mentor. Include strengths, your special skills, and the contributions you can make to other students and to the University as a Mentor.