Devils Advocate Mentoring Program Protg Information Packet 2011-2012

Name: _____________________________________________________________ Email: _____________________________________________________________ Cell Phone: _________________________________________ Major: ____________________________________ Expected Graduation: ________________

I am interested in becoming a Protg because (check all that apply): ____ Seems like a positive way to connect with USciences ____ I am seeking support in my experience at USciences ____ I am interested in gaining professional development ____ I am looking for insight into academic success How would you describe your communication style? ____ Life of the party ____ Friendly and outgoing ____ Usually wait to be approached by someone new ____ Reserved until I get to know someone new ____ None of the above (Please describe): ________________________________________________ What type of student would you prefer as an Advocate? ____ Assertive, the one who takes the lead ____ Very involved and open ____ Participatory but not too assertive ____ Reserved and on the quiet side ____ Any style is fine with me ____ Other (Please describe): __________________________________________________________ Please indicate the following criteria you would prefer in an Advocate: ____ Same gender ____ Same ethnicity ____ Similar career interests ____ Similar personal interests ____ Other (Please specify): __________________________________________________________ ____ No preference

Please indicate those activities that you see as most important in a mentor relationship: ____ Give advice on career options and decision making ____ Make job and resource referrals ____ Assist in job readiness activities ____ Assist in post-secondary education or training plans ____ Assist in social skills development ____ Provide encouragement and support ____ Other (Please specify): _________________________________________________________ How did you learn about the Advocate program? ____ Approached by staff at USciences ____ Approached by faculty at USciences ____ Friend ____ School colleague/Club or Organization ____ Other (Please specify): ___________________________________________________________ Do you have a preference for someone you would like as an Advocate? (Name): ________________________________________________ Is there anything else you would like us to know about you? Example: Talents, Areas you would like to volunteer with, on- and off-campus activities/organizations you are a part of, etc?

Why do you want to be a Protg?:

Signature verifies that the information you have provided in this Protg Information Packet is accurate to the best of your knowledge.

_______________________________________________________ Print Name Date

_______________________________________________________ Signature Date