PNMGC Peer Mentoring Program

Mentor Application

Basic Information
* First Name
* Last Name
* Email address
* Confirm Email
Contact Information
City
State
Phone
Mobile Phone
Work phone
Preferred Method of Communication
Home PhoneCell Phone
Work PhoneEmail
Demographic Information
* Date of Birth
Gender
Sexual Orientation
Primary Language
Primary Language Other
Ethnicity
Ethnicity Other
Education
Education level
* Major Field(s) of Study
* Degree(s)
Other Degree(s)
Graduate Degree(s)
Research Interests
Profession and Employment Information
* Profession
Other Profession(s)
Position Title
Interests and Hobbies
Career Focused Interests
Career Focused Interests Other
Skills
Hobbies and Interests
Hobbies and Interests Other
Please list involvement with outside organizations
Other info
What would you like to be matched on?
Program Questions
* How confident do you feel in completing your program?
Country of Origin
Additional info
Gender
* UNM Affiliation
Student ID Number (for scholarship purposes only)
* Previous Participation
* Specific match request
Name of requested match
* Availability
Additional info

* - Required field