The purpose of the Latino Mentor Program is to promote and enhance student retention and academic success. Please keep in mind that you don't have to belong to a specific ethnic group/minority to participate. The program is devoted to the success of NKU students.

Please complete the following information form as accurately as possible. If you have any questions or comments, do not hesitate to contact Latino Programs & Services at 572-5821 or 572-6013
 
 
 
 
 


Were you born and raised in the United States?:

If the answer is NO, please explain:

Residency Information

 
 

 

 
 

 

 
 

Contact Information

 
 
 
 
 
 
 

BEST WAY TO REACH YOU:

BEST TIME TO REACH YOU:

Emergency Contact Information

 
 
 
 
 
 
 

Academic / Work Information

 

OTHER ACADEMIC AREAS OF INTEREST:

 

WHAT IS YOUR CLASS SCHEDULE?:

NAME OF EMPLOYER:

WHAT IS YOUR WORK SCHEDULE:

Are you involved in student organizations? If so, please list type of activity and positions you have held:

Mentor Information

Why do you want to be a mentor? Please include strengths, special skills and contributions you can make to other
students and the univesity as a mentor.

Please list three activities you like to do during your free time.

Please list three of your hobbies.

Please list three activities you would like to do with your mentee.

Do you have any special requirements for your matching Kroger mentee? For example, I would like a female mentee
or someone interested in the same professional field. (See confidentiality agreement below).

OTHER COMMENTS:

ADDITIONAL DOCUMENTS:

The following documents need to be included with this application: Unofficial High School Transcripts and Academic Schedule.

CONFIDENTIALITY AGREEMENT:

All the information disclosed in this application shall be confidential and for the sole use of the NKU Latino Student Affairs office.