Mentee Application Form – Fill Out and Use This PDF

The Impact Project: A Women’s Mentoring Program

MENTEE APPLICATION FORM

This is made possible by the UTEP Communication Changemaker Award (awarded by the Social Justice Initiative)

in partnership with The Women’s Resource Center at The University of Texas at El Paso

If you are interested in participating in this program as a MENTEE, please return the completed application by

Monday November 15, 2010 at 5 p.m. at the Women’s Resource Center Union West 112 or fax 747-5215.

Positions for this program are limited.

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Applicant Name: _______________________________________________________________________

Major/Department: _______________________________________ # of Credit Hours Completed: ______________

Preferred e-mail: ___________________________________ Phone: ______________________________________

Most Recent Employment: __________________________________________________________________________

Type of position: Supervisory ____ Non-supervisory ____ Administrative ___

Classification: Senior ____ Junior ____ Sophomore ____ Freshman ___

Part-time Student ____

Full time Student ____

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Have you ever HAD A MENTOR in your work/student life?

No______ Yes______ Was this a formal or informal mentoring experience? _________________________________

If yes, please describe your areas of development and how you benefited:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

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Mentees may suggest someone they would like as their mentor. Mentors may be women who work at the University, with whom you would like to establish a relationship.

Do you have a particular mentor with whom you would like to be paired?

No_______	(We will match you with a mentor based on your background and needs.)
Yes ______	Name of desired mentor: _______________________________ Phone: _________________
	Have you contacted the mentor, or would you like us to contact her/him?
	-Have contacted ____
	-Have not contacted, but will contact____
	-Please contact for me____

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Please assess your skills and abilities in the following areas:

	Weak				Strong
Communication skills	1	2	3	4	5
Presentation skills	1	2	3	4	5
Leadership skills	1	2	3	4	5
Thinking skills	1	2	3	4	5
Time management	1	2	3	4	5
Problem-solving skills	1	2	3	4	5

Based on your developmental needs, please indicate the top 6 areas on which you would like to focus with your mentor. Rank order them with “1” indicating the most important area.

____ Decision Making

____ Career path/tenure track development

____ Development of a research agenda

____ Development of a knowledge base

____ Development of a skill base

____ Overcoming obstacles to career development

____ Sounding board for ideas

____ Emotional and social support

____ Self awareness and discipline

____ Prioritization

____ Time Management

____ Effective Communication

____ Networking

____ Leadership Skills

____ Strategic Thinking

____ Greater inclusiveness into institution

____ Organizational knowledge

____ Others (please list): _________________________________________________________

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How much time are you able and willing to dedicate to mentoring? (At the beginning of the year, each mentor/mentee pair agrees upon when and how often to meet based upon each individual’s schedule. Typically, partners will meet

about one-two times per month for about one hour.)

One hour per week______ One hour per month_____ Two hours per month_____

Other (please explain) ____________________________________________________

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Please attach a copy of your current resume

To assist us in matching you with a mentor, please answer the following questions in 200 words or less on a

separate page.

1.What benefits do you hope to gain from participating in this mentoring program?

2.Describe any concerns you have about participating as a mentee in the Mentoring Program. Please be specific. For example, while we typically pair staff mentees with a staff mentor, and faculty mentees with a faculty mentor, we are open to being flexible based upon your needs as a mentee.

Questions?

Contact the Mentoring Program Coordinator, Ambar J. Calvillo, at 747 - 8896 or wrcintern@utep.edu

Return completed application by Monday November 15, 2010 at 5 p.m. to:

The Women’s Resource Center at Union West 112 or fax to 747-5215

*All selected mentees will be notified on Friday November 19, 2010 by 5 p.m. with further information.