Fillable MALES-MentorsApplication-2018 Men Advocates for Leadership, Excellence & Success (M.A.L.E.S.)

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MALES-MentorsApplication-2018 Men Advocates for Leadership, Excellence & Success (M.A.L.E.S.)

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Men Advocates for Leadership,
Excellence & Success (M.A.L.E.S.)
Mentor Application
Document Name: MALES-Mentorsapplication-2018.Docx Page 1 of 2
Men Advocates for Leadership, Excellence & Success (M.A.L.E.S.)
Mentor Application
INTRODUCTION
M.A.L.E.S. 504 College Drive, Albany, GA 31705
Office Reese Building Room 107
Telephone: (229) 430-1821 Fax: (229) 438-2782
DIRECTIONS: This application must be typed, and all information must be completed. All information obtained from this
application form shall be held in strict confidence.
PERSONAL INFORMATION
NAME: _______________________________ ________________________________ ________ DATE OF BIRTH: _________________
First Last Int.
GENDER: _______________________________________ RAM ID: _________________________________________________________
E
THNICITY: ______________________________________ RELIGIOUS PREFERENCE: ______________________________________________
GPA
(CUMULATIVE): ____________ MAJOR: ________________________________ CLASSIFICATION: _______________________________
If a first year freshman, please use high school GPA
First Generation Student (Parents did not attend college) □ Yes □ No
LOCAL MAILING ADDRESS:
___________________________________ ___________________________________________ _____________________________
Number Street Apt Number
_________________________________________________ ________________________________________ __________________
City State Zip
TELEPHONE: ____________________________________________ ________________________________________________________
Home Area Code Number Mobile Area Code Number
E-MAIL: ________________________________________________________________________________________________________
S
OCIAL MEDIA INFO: _______________________________________________________________________________________________
Men Advocates for Leadership, Excellence & Success (M.A.L.E.S.)
Mentor Application
Document Name: MALES-Mentorsapplication-2018.Docx Page 2 of 2
GENERAL INTERESTS
Special Interest/Talents: _________________________________________________________________________________________
Mentor experience (if applicable): _________________________________________________________________________________
What do you feel you can bring to the MALES mentorship program? _____________________________________________________
I need a mentor (check one) □ Yes □ No
*I want to be a mentor (check one) □ Yes □ No
AUTHORIZATION
I agree that the above information is true and accurate to the best of my knowledge and agree for its usage in MALES
Mentors. I also understand my information will be used for review and selection into the MALES mentoring program.
_________________________________________________________________________________________________
Student’s Signature Date
NAME: _______________________________ ________________________________ ________ DATE OF BIRTH: _________________
First Last Int.
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MALES-MentorsApplication-2018 Men Advocates for Leadership, Excellence & Success (M.A.L.E.S.)

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Completed 25 February 2020

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