Last Name: First Name:
Major: Area Code: Phone #: Area Code: Cell #:
Do you work? Yes No If so, how many hours per week?
Do you have children? Yes No If so, how many children and how old are they?
What are your academic goals as a Cuyamaca College Student? (check all that apply) To improve basic skills such as English or Math Improve job/career skills To obtain a certificate To obtain an AA or AS degree To prepare for transfer to a baccalaureate program Other (explain):
While enrolled, will you be: (check all that apply) taking classes during the evening? taking classes during the day? employed?
In which of the following student services are you interested? (check all that apply) Career Assessment/Planning Study Skills Counseling Time Management (i.e., class, work, study schedule, family, leisure time) Reading Textbooks Note-taking Locating and using information resources (i.e., libraries, internet) Preparing for and taking examinations Tutoring Center Math Study Center English Writing Lab Other:
If transfer is a goal, indicate which college/university: San Diego State University University of California, San Diego University of San Diego Other: Undecided
What are your lifetime goals? (check all that apply) Having a career you enjoy. Earning a lot of money. Owning a home. Traveling. Marriage Children Other:
What do you hope to gain from your mentoring experience?
What would you like your mentor to know about you?
How do you feel about meeting your mentor?
If matched with a mentor, I agree to the following conditions:
I do hereby understand and agree to the above commitments and responsibilities and attest that all of the information I have provided on this application is correct to the best of my knowledge.