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 MSLI Faculty or Staff Mentor Application  

 
  CONTACT INFORMATION
   
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Please list the primary phone number you would like us to use to contact you. Include area code and number: (123) 456-7890
 
   
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  ABOUT YOU

The following information about your identity, interests, experiences, and needs will be used to match you with your mentee and faculty or staff mentor as well as help us provide a supportive program environment. Please respond within your comfort level.
   
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Please feel free to include all groups that comprise your heritage or identity.
 
   
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This is how you identify in terms of the nation(s) in which you grew up and/or hold citizenship. E.g., American, Nigerian, Sri Lankan, Guatemalan, Japanese, etc.
 
   
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If none are required, write "None".
 
   
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(Select "No" if one or more of your parents attained a bachelor's degree)
 
   
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This information is used to provide you with an MSLI shirt.
 
   
  APPLICATION

The following information will be used to help us select participants.
   
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Applicants may include on-campus and off-campus experiences.
 
   
  By signing below, applicants agree to the following:

If accepted into the MSLI program as a faculty or staff mentor, I will commit to being an engaged participant in MSLI activities during the fall 2015 and spring 2016 semesters. This includes regular participation in meetings with my mentoring Triad (every two weeks), attending mentor training sessions and other MSLI group events (two to four per semester). I will participate in program surveys and assessments. I will work to cultivate a positive, professional, and supportive mentoring Triad. I will keep the MSLI Committee apprised of how my Triad relationships are progressing, as needed, or when updates are requested.
   
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