Beta Chi Mentoring Program: Mentee Information Form

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Thank you for your interest in participating as a mentee in the Beta Chi Mentoring Program. We want to know more about you so we can properly match you with a mentor. Please complete this brief information form.

Name *

Email *

Phone Number

I am enrolled in the *

Clinical Mental Health Counseling Program

School Counseling Program

Other:

Semester in the Program *

1st

2nd

Other:

What semester do you plan to start the mentoring program?

Fall 2016

Spring 2017

Fall 2017

Spring 2018

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What days and times will you plan to be on campus during the semester indicated above?

This mentoring program is structured around full semester mentoring participation. We will try to have a select number of mentors available on a rolling basis, in case you decide to apply to the mentoring program midway through the semester. Although we will try to accommodate, we cannot guarantee that we will have mentors available for mid-semester applicants.

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