Faculty Mentoring Program

Student Application

Spring 2015 Applications Due: Friday, January 30, 2015

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.

Personal Information

Mr.
Mrs.
Ms.
Miss.

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(Exclude Dashes)








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Provide school email @cougars.csusm.edu
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MM/DD/YYYY


Optional







Biographical and Economical Background
Please indicate the highest level of school/education completed for each parent
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If your parent completed college, please note degree attained

Degree attained

Degree attained


Education Information

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Freshman
Sophomore
Junior
Senior


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Bachelor of Arts/Science
Master of Arts/Science
Teaching Credential
Doctorate


EOP
SSS
DSS
Other



Financial Information
The following information is used to determine income elegibility for FMP.
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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.

Program Outreach

Mailer
Faculty Mentor
University website
Student
Cougar channel
Orientation
In the loop
The Pride
Other

Do you give the Faculty Mentoring Program permission to provide your assigned mentor with your contact information other than your email address?

Phone Number
Home Address
Email Only


The following section is important in being selected!

Autobiographical Statement
The following information is important in being selected for the Faculty Mentoring Program and yours assignment to a mentor. Please read the questions carefully and answer them in the box below. Type your answer and keep it to no more than two pages. Please note that if selected for the Faculty Mentoring Program, your mentor will receive a copy of your autobiographical statement.
1. In what ways do you see a mentor being helpful to you?

2. The following questions may be answered.

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.
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.



I certify that the information submitted in connection with my application to the Faculty Mentoring Program is complete and accurate.


Enter your initials

Enter today's date MM/DD/YYYY
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