Fillable EMP Student Mentee Application Fillable (University of West Florida)

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EMP Student Mentee Application Fillable (University of West Florida)

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The EMP Student Mentee Application Fillable (University of West Florida) form is 5 pages long and contains:

  • 2 signatures
  • 36 check-boxes
  • 65 other fields

Country of origin: US
File type: PDF

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Thank you for your interest in the Executive Mentor Program. This application will
allow us to successfully match our students with experienced executives.
First Name: ________________ Nickname:_______________ MI: ______ Last Name: ___________________
Suffix: _________ Gender: Male Female Student ID # ___________________________________
(Sr., Jr., III)
Ethnicity: (optional) (Please check all that apply)
Hispanic or Latino Descent American Indian or Alaska Native Asian
Black or African American Native Hawaiian or Other Pacific Islander White Other
Current Degree Program at UWF:
General Business Management Management Information Systems
Accounting Finance Economics Global Economics
Marketing Global Marketing Sales Management Supply Chain Logistics
MBA MACC
Interest in being an entrepreneur
Expected Graduation:
Please attach your Resume to this application: Attached
If you would like help creating your resume, please contact
Career Services at 850.474.2254 or career@uwf.edu
1 of 4
Hospitality
UWF College of Business | 11000 University Parkway | Pensacola, FL 32514
Month______________ Year______________
Local Mailing Address:______________________________________________________________________________
City: ___________________________________State: _______________ Zip Code: _____________________________
Cell Phone: _____________________________________ Home Phone: _____________________________________
UWF Email Address: ________________________________________________________________________________
Home Mailing Address: _____________________________________________________________________________
City: _________________________________________ State: _______________ Zip Code: _______________________
Do you have a preference for your Mentor’s industry/specialization? We will try to
accommodate your preference, but may not be able to do so given the pool of Mentors.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Do you have access to a car? Yes No
Education:
Academic Standing: Junior Senior Masters/Graduate GPA: ______________
Prior College/University Name(s): _____________________________________ Years Attended___________
Degree(s) Earned: _____________________________________
High School Name: _____________________________________________ Graduation Year: ________________
High School City: ________________________________________________ State: ____________________________
High School Clubs, Organizations & Activities: ___________________________________________________
________________________________________________________________________________________________________
2 of 4
Personal Email Address: _______________________________________________________
UWF College of Business | 11000 University Parkway | Pensacola, FL 32514
I’m a… (optional) (Check all that apply)
International Student Student with Disabilities
First Generation Student Adult Student Active Military or Veteran
Personal Summary: Be honest and give your future mentor a view of who you are, and how
your life experiences so far have shaped you.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Career Plans and Aspirations: Honestly answer the question, “What do you want to be
when you grow up?”
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Hobbies/Interests: Do you play an instrument? Are you skilled in a specific sport or have a
favorite team? Tell your potential mentor what you do for fun.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
3 of 4
UWF College of Business | 11000 University Parkway | Pensacola, FL 32514
Why I want an Executive Mentor: What are some of the things you would want your
mentor to help you with? Identify what you expect of your mentor, from a specific industry
to the goals for your career most in need of help.
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
The following person has recommended me for this program:
Name: ________________________________________________________________________________________________
Title: __________________________________________________________________________________________________
Company: ____________________________________________________________________________________________
Email: ________________________________________________________________________________________________
Phone: ________________________________________________________________________________________________
By checking this box and submitting this application you acknowledge that the information
is true and accurate to the best of your knowledge.
Thank you for applying. You will be contacted by the UWF Executive Mentor Program soon.
Authorization for Release of Student Information (in accordance with FERPA):
I authorize UWF to release information from this application and the resume I submit to
potential mentors to facilitate the matching process with a business executive.
The above information may be released with my full consent.
Signature: ______________________________________________________________ Date: ______________________
Return Application: Building 76A/224 | Fax 850.474.2342 | executivementor@uwf.edu
4 of 4
UWF College of Business | 11000 University Parkway | Pensacola, FL 32514
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I authorize the University of West Florida, acting for and on behalf
of the University of West Florida Board of Trustees (“University”)
and those acting pursuant to its authority to:
record my likeness and/or voice on a video, audio, photographic, digital,
electronic or any other medium;
use my name and biographical material in connection with such recordings; and
use, reproduce, exhibit, and/or distribute my name, biographical material, and
such recordings in any medium (e.g., print publications, video, internet, etc.) for
a variety of promotional, advertising, educational, and/or other lawful purposes.
I agree to release the University from all liability related to the recordings and waive
any claims or rights of compensation or ownership regarding such uses, and agree
and understand that all such recordings shall remain the property of the University.
❑ Student ❑ Faculty ❑ Sta ❑ Other
Name of Participant
(Please print)
Signature of Participant Date
(If 18 or older)
IF UNDER 18:
Legal Guardian Name
(Please print)
Legal Guardian Signature Phone number
Email
OFFICE USE ONLY:
Project/Intended Use
Filed By
Photo/Video Release Form
(i)
(ii)
(iii)
Institutional Communications | brand.uwf.edu | uwf.edu/institutionalcommunications
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EMP Student Mentee Application Fillable (University of West Florida)

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Completed 25 July 2020

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