Mentor Application Form

First Name*Last Name*City/State*Phone*Email*LinkedIn Public Profile URL* Are you a:

• Student
• Alum
• Community supporter

How did you hear about the mentor group? Marylhurst University website Social media (Facebook, Twitter, LinkedIn) Family member or friend Other
If Other:What are you hoping to gain from connecting with a mentee?*Support you can provide*Hobbies*Proud/recent accomplishments*Goals & ambitions*Gender (Optional)

• Female
• Male

Age (Optional) 20 and younger 21-29 30-39 40-49 50-59 60 and older Prefer not to answer
Ethnicity (Optional) American Indian / Alaska Native Asian / Pacific Islander Black, non-Hispanic Hispanic White, non-Hispanic Non-resident alien Prefer not to answer