Mentor Matching Form ES Cohort 2022

Name: Race/Ethnicity: Date of Birth:

Gender:

Language(s) spoken in your home:

Areas of Interest for College Study (circle any that apply):

Advertising/Marketing Visual Arts Business

History Education Engineering
Political Science Math Health Care and
Medicine
Social Journalism Environmental Studies
Work/Psychology Publishing Performing Arts
Languages Computer Undecided
Natural Sciences Science/Tech

Circle three adjectives that best describe your personality?

engaged
curious compassionate
shy friendly
outgoing anxious
adventuresom conversational
e spiritual
ambitious silly
easygoing introspective/reflective
energetic other:

What areas do you most want mentor support-- where you think your
mentor can most impact your life (circle all that apply)? 
 knowledge of career fields
social support network
building self-confidence
improving communication
skills
improving organizational skills
Other (please specify): 
Please indicate your hobbies and interests (circle all that apply): 

Leisure Reading Writing

Visual Arts Sports (specify):
Film Dance
Travel Other (please specify):
Music Technology
Volunteering Outdoors

ES Scholars communicate regularly with mentors.  What is your preferred

method of communication (circle one)? 

Ema
il
Phone Ca
Text
Would you prefer to be matched with a mentor of the same gender
(circle)? 
Yes
No
No
Preference

Short Answer Section: