BUMP UP Mentoring Program Application

PROGRAM APPLICANT DISCLOSURE

PLEASE BE AWARE:

Mentee Requirements:

  • Be willing to communicate with the mentor monthly.
  • Be willing to attend the initial program orientation.
  • Be willing to communicate regularly with the program coordinator.
  • Be open to receiving advice and referrals from your mentor.
  • Take equal responsibility in the mentoring relationship by initiating and maintaining contact with the mentor.
  • Seek advice and counsel from your mentor and program coordinator.
  • Work with your mentor to establish realistic goals.
  • Promptly return phone calls and emails from your mentor.
  • Keep your mentor aware of any changes to your address, phone number, major, email address, etc.
  • Participate in workshops and activities sponsored by the mentoring program.
  • Contact the mentoring program coordinator if there are any concerns regarding your mentoring activities.
  • Comply with all code of conduct and discipline rules.
BUMP UP MENTORING PROGRAM APPLICATION
Personal Information
Your Student ID (also known as your MyCSN ID or NSHE ID) is a 10-digit number assigned to you upon being admitted to the college. If you are unaware of what your Student ID is, please contact the Office of the Registrar at (702) 651-4060.
CONTACT INFORMATION
ADDRESS
EMERGENCY CONTACT INFORMATION
EMERGENCY CONTACT ADDRESS
OTHER INFORMATION
Did either one of your parents earn a degree from a four-year college or university?

 

Please read carefully before signing:

The BUMP UP mentoring program appreciates your interest in becoming a student mentee. Please initial each of the following:



I authorize the College of Southern Nevada to use any photographic image of me taken while participating in the mentoring program. These images may be used in promotions or other related marketing material. 


 

Please complete the CSN Individual Authorization for image / Publicity Release form. 
The publicity Release form is available by clicking here:

Applicant Signature

Today's Date: 2019-05-25 05:51