Cleveland State University

Alumni & Friends

STAT Alumni Mentor Program
Mentor Application

Graduation Year* Degree
Daytime Phone No. Evening Phone No.
Preferred E-mail*
Preferred Mailing Address
City, State, Zip
Best time/place/method (voicemail, email, etc.) to reach you.
Career Field Job Title
Areas of Expertise/Responsibility
Do you authorize the CSU Alumni Association to release your contact information to a student mentee so that he or she can contact you?
Would you prefer to mentor a female or male student, or do you not have a preference?
FemaleMale No Preference
Have you served as a mentor before?
Yes No
If yes, please describe that relationship.
Why are you interested in serving as a mentor?
Did you participate in any clubs, activities, or sports while at CSU? If so, which ones?
Do you have any specific interests or hobbies that you would like to share with a student mentee?
Would you like to provide any other information that would assist in making a good match?
What does being a mentor mean to you? What are your expectations for this program?
In addition, would you be interested in the following volunteer opportunities (check all that apply):
Join an Alumni Chapter
Organize local alumni events
Host local alumni events
Help to organize a class or departmental alumni reunion
Serve as a class representative
Be an alumni guest speaker
Be involved in a governance and/or advisory group
Assist in recruiting/advising prospective students
Be a contributing writer for alumni publications

Mentor Acknowledgement: By submitting this application you agree to serve as a mentor in the STAT Alumni Mentoring Program for the 2010-11 school year. As a mentor, you shall make initial contact with your assigned mentee and agree to meet with your mentee at least 2 times a semester.

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Mailing Address
Cleveland State University
2121 Euclid Avenue, MM 212
Cleveland, OH 44115-2214
Campus Location
Mather Mansion, Room 212
2605 Euclid Avenue
Phone: 216.687.2078

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