Faculty Mentoring
Program Application
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Fall 2008
Applications Due: Friday, September 5, 2008
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You must be
enrolled
at CSUSM the term you are applying for the Faculty Mentoring
Program in order to be considered. Answer all
questions on the form or indicate N/A if not applicable.
Information will be kept confidential and used only in
determining your eligibility for the program. |
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Personal
Information |
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Title: Mr.
Mrs.
Ms.
Miss |
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First Name
Middle
Initial
Last Name
Suffix
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Student ID
(exclude dashes) |
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Mailing Address |
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Street Address
Apt./Unit
City
State Zip
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Home
Phone ()
i.e (760)750-4000 Work Phone
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CSUSM Email
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Birthday
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Gender
Ethnicity
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Are you a Veteran? Do you have a verified disability?
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If so, what is your verified disability?
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Marital Status Number of Dependent(s)
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Do you work while attending Cal State San Marcos?
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Biographical and Economical Background |
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Please indicate the highest level of school/education
completed for each parent |
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Mother |
Father |
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If either parent completed college, please note degree
attained |
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Mother |
Father |
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What language(s) are spoken at home
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Educational Information |
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Are you currently enrolled at CSUSM? Yes No.
of units No |
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Class Standing: Junior Senior |
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Tentative Graduation Date
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Academic Major |
Minor |
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What degree(s) do you plan to achieve? |
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High school last attended |
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Program participation (check all that apply) |
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Financial Information |
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The following information is used to determine income
eligibility for FMP |
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Were you awarded a Pell Grant? |
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*If you do not receive a Pell
Grant but consider yourself financially disadvantaged,
please describe your financial situation in the
autobiographical statement. |
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Program
Outreach |
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How did you hear about the Faculty Mentoring Program? |
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Do you give the Faculty Mentoring Program permission to
provide your assigned mentor with your contact information
other than your email address? Please indicate your
preference(s). |
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Phone Number |
Home Address |
Email Address Only |
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Autobiographical Statement |
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The following information is important in being selected
for the Faculty Mentoring Program and yours assignment to a
mentor. Please read the question carefully and answer
them in the box below. Type your answer, name on the
top right corner of the page. Keep it to no more than
two pages, double-spaced and submit with your
application. Please note that if selected for the
Faculty Mentoring Program, your mentor will receive a copy
of your autobiographical statement. |
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- In what ways do you see a mentor being helpful to
you?
- Answer A if you plan to attend graduate school.
Answer B if you plan to work immediately after earning
your BA or BS.
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Please indicate which question you plan to answer |
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A. Graduate/Professional School: If
you plan to attend graduate or professional school, please
tell us the field or discipline you plan to pursue, the
university or professional school you would like to attend
and why you have selected that field. Feel free to add
anything else you think we should know so that we may be
able to help you plan accordingly. |
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B. Career/Work Aspirations:
If you plan to work immediately after the BA/BS degree,
please indicate what type of work you plan to enter, your
long-term occupational goals, where you want to locate
and anything else you think we should know in order to help
you plan for reaching your goals. |
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