ALABAMA A&M UNIVERSITY
CHANGING LANES MENTORING PROGRAM
MENTOR APPLICATION

The following questions will assist us in assigning you to a mentee. Please complete the form below and click the submit bottom upon completion. For further information please feel free to contact The Office of Retention and Academic Support at (256) 372-5493 or email us at ChangingLanes@aamu.edu

Last Name First Name
AAMU ID
Dorm Phone Number (Area code first) Cell Phone
Email Facebook ID
Contact Address
City State ZIP code
Gender: Male Female

Area to be completed only by student mentor
Classification: Sophomore Junior Senior Graduate Student
Transfer International
Major Minor

Area to be completed only by faculty, staff and professional mentors
Classification: Student Faculty Staff Professional
What is your field?
What are your areas of interest?
Which department are you employed by
Have you lived or studied abroad? Yes No
If yes, which country?

This section must be completed by all applicants
Which best describes your personality? Introvert Extrovert Average
Indicate your religious preference
Describe any activities in which you are currently involved that may allow you to connect a mentee.
List your extracurricular activities.
What are your expectations of the mentorship relationship?
Please indicate the number of mentees that you will be willing to work with
Please provide us with any information that may assist in selecting a mentee for you
The information provided will be treated with the strictest confidence and will not be shared with anyone outside this office. Can we provide your selected mentee with your contact information? Yes No

If you have any questions about the program, or your mentoring relationship please feel free to contact the Office of Retention and Academic Support at:
Phone: (256) 372-5493
Fax: (256) 372-5495
Email:howard.wright@aamu.edu