IT’S ALL ABOUT
IT’S ALL ABOUT
IT’S ALL ABOUT
MENTEE INTEREST
The Dual Degree Program
Full Name ____________________________________________ Preferred Name ____________________________________________
Cell Phone (______) _____________________________________ Home Phone (______)______________________________________
School E-mail __________________________________________ Personal E-mail ____________________________________________
Address _______________________________________ City, State, ZIP____________________________________________________
Major/Minor ____________________________________ # semesters in DDP________________________________________________
Career Interests/Professional Goals ___________________________________________________________________________________
Community college attended/attending:
0 City Colleges of Chicago 0 College of DuPage
0 Harper College 0 Joliet Junior College 0 Kankakee Community College 0 Moraine Valley Community College
0 Morton College 0 Prairie State College
0 South Suburban College
0 Waubonsee Community College
0 Triton College Currently enrolled at GSU: 0 Yes 0 No
If not, anticipated enrollment at GSU: Term 0 Fall 0 Spring 0 Summer Year_________
What are your interests, hobbies, extracurricular activities (jobs, clubs, committees, internships, volunteerism, etc.)?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Why do you want to be paired with a peer mentor? How do you think you will benefit?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
List 3 words that best describe you: ________________________
________________________ __________________________
Please list anything else you would like us to know about you that will help us make a good match for you:
____________________________________________________________________________________________________________
Questions? Contact DDP Coordinator of Peer Mentoring, Tiesha Walker, at [email protected] or 708.235.7539.
Submit the completed form to the address below or email it to [email protected], or fax to 708.235.7455.
Governors State University
Office of Admission - DDP
1 University Parkway
University Park, IL 60484
Next steps: Upon receipt of your Mentee Interest Form, we will match you with your mentor and email you information about your mentor.
Your mentor will then contact you.
04/2015