Cuyamaca College
First Year Success Mentor Program
Mentor Information Sheet

Last Name: First Name:

Address:

City: State:      Zip:     

Area Code: Phone #: Area Code: Cell #:

E-mail address: @. com net edu Gender: Male Female

If employed, what kind of work do you do? Please list your title and responsibilities:

What are your hobbies or interests? How do you like to spend your free time?

Degrees and/or certificates earned (Include college/university name and field of study):

Who was an important role model or mentor for you, and why?

In working with community college students, please describe your experience(s):

Are you affiliated with any community, civic, or professional associations? If so, which ones?:

Languages spoken:

If matched with a mentee, I agree to the following conditions:

• To make a one semester commitment
• To ask for assistance when I need help with the mentoring relationships.
• To work closely and cooperatively with FYSP staff during all phases of the program.
• To notify FYSP Mentor Program Coordinator and my mentee when I am unable to keep my commitments.

  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.