PNMGC Peer Mentoring Program

Mentor Application

Basic Information
* First Name
* Last Name
* Email address
* Confirm Email
Contact Information
Mobile Phone
Work phone
Preferred Method of Communication
Home PhoneCell Phone
Work PhoneEmail
Demographic Information
* Date of Birth
Sexual Orientation
Primary Language
Primary Language Other
Ethnicity Other
Education level
* Major Field(s) of Study
* Degree(s)
Other Degree(s)
Profession and Employment Information
* Profession
Other Profession(s)
Position Title
Interests and Hobbies
Career Focused Interests
Career Focused Interests Other
Hobbies and Interests
Hobbies and Interests Other
Please list involvement with outside organizations
Program Questions
Country of Origin
Additional info
* UNM Affiliation
* Student ID Number
* Previous Participation
* Specific match request
Name of requested match
* Availability
Additional info

* - Required field