The NKU Latino Programs and Services Mentor Program promotes and enhances 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 and Services at 572-5821 or 572-6013
 
 
 
 
 


Where you born and raised in the United States?

If your answer is NO, please explain:

 

CURRENT STATUS (Please check one):

HAVE YOU BEEN ASSIGNED A MENTOR BEFORE? If yes, please give details.

Residency Information

CURRENT RESIDENCE (Please check one):

 
 

 

 
 

 

 
 

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 WORK SCHEDULE?:

QUESTION: Were you involved in student organizations while you attended high school. If so, please list type of
activity and positions you held: 

QUESTION: While you attended high school, were you involed in ay extracurricular activities within the school or community? If so, please list the type of activiity and positions you held:

Mentee Information

Please list three activities you like to do during free time:

Please list three hobbies:

Please list three activities you would like to do with your mentors:

Do you have any special requirements for your matching mentor? For example: I would like a female mentor or someone in the same professional field. (See our 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.