UHM Mentor Mentee Title

 

 

 

MENTOR APPLICATION

Please complete this form if you would like to help a new international student adjust to life in Hawai'i. Click SUBMIT at the bottom after completing the form. Ideally, you will be assigned a Co-Mentor and 3-4 Mentees in your group. It is a responsibility for mentors to attend Mentor Orientation.

 * required field
You application will not be processed if you miss any required field. 

Last Name*: First Name*:
Gender*: Female  Male  Married Date of Birth*: mm/dd/yy
UH ID: Major*:
Education Level*: Graduate   Undergraduate  Exchange
Home Country*:
Languages Spoken:
Email*: @hawaii.edu Phone:
Hobbies, Interests:

* * *

CO-MENTOR PREFERENCES
(not guaranteed)

Nationality:
Gender: Female Male No preference
Degree: Undergraduate Graduate No preference
Other Preferences:

* * *

MENTEE PREFERENCES
(not guaranteed)

Nationality:     No preference
Gender: Female Male No preference
Degree: Undergraduate Graduate No preference
Other Preferences:

* * *

MENTOR AGREEMENT

  1. I agree to commit as a Mentor from the day I am assigned a Mentee to the end of the program.
  2. I agree to attend the Mentor Orientation at the beginning of the commitment term.
  3. I agree that ISS can provide the following information about me to other Mentors and Mentees: Name, Gender, Major, Student Classification, Home Country, and E-mail Contact (@hawaii.edu).
  4. I agree to send my Co-Mentor and Mentees an introductory e-mail and meet with them in person at least twice. I also agree to attend the Mentor Mentee Welcome Party and at least one of the other activities.
  5. I agree to respond to any e-mail sent to me by my Co-Mentor and Mentees.
  6. I agree that any personal information shared by the Mentors and Mentees is considered confidential, and I will not share this information without express permission.
  7. I agree to respect the UH Manoa Student Conduct Code.
  8. I agree not to enter into a consensual, romantic relationship with the Mentors and Mentees while participating in the Mentor Mentee Program, therefore, I agree there will be no physical contact of a romantic nature with participants.
  9. I understand that at any time during my participation in the program, I can contact the Mentor Mentee Program coordinator, assistant or advisor with any concerns, problems, or issues.
  10. I agree that I, my Co-Mentor or Mentees may terminate the relationship at any time. If the relationship is terminated, I agree to immediately inform the Mentor Mentee Program coordinator, assistant or advisor.
  11. I agree that the Mentor Mentee Program may terminate a Mentor Mentee relationship at any time.
  12. I understand that all Mentees participating in the program will be required to agree to a similar agreement.
  13. I agree the only exception to the above item are in those dire cases when a Mentor or Mentee may share information with me that leads me to believe the Mentor and Mentee may be in danger to him/herself or others around them. In these cases, I agree to contact the Mentor Mentee Program coordinator, assistant or advisor immediately to notify them of the situation, who may be required to inform other university officials.

*I have read and understood this Mentor Agreement of the Mentor Mentee Program.