Professional Advising Mentoring (PAM) Volunteer Application Home Students Office of Civic Engagement and Career Development Professional Advising Mentoring (PAM) Network Professional Advising Mentoring (PAM) Volunteer Application More in this Section Professional Advising Mentoring (PAM) Network Professional Advising Mentoring (PAM) Volunteer Application Please fill out the form below. Required fields are indicated with a * symbol. Thank you. Full Name First Name MI Last Name Gender Male Female Prefer not to answer Mailing Address Address Line 1 City Alabama Alaska American Samoa Arizona Arkansas Baker Island California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Jarvis Island Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Maryland Massachusetts Michigan Midway Atoll Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands United States Virgin Islands Utah Vermont Virginia Wake Island Washington West Virginia Wisconsin Wyoming State Zip Email Preferred Contact Number Home Phone Cell Phone Work Phone Employer Length of Employment Education completed High School Undergraduate degree in School Advanced degree(s) in School Complete How was the Program brought to your attention? What motivated you to apply to the Program? Will you be able to meet with a student at least once a month during the school year? Will you be able to meet with a student at least once a month during the school year? Yes No What are you hobbies, special skills, or other interests? What do you like to do in your leisure? What other affiliations (e.g., service or volunteer organizations) do you have? What do you hope to gain from the mentoring experience? What do you hope your mentee gains from the mentoring experience? Do you have prior mentor experience? Do you have prior mentor experience? Yes No If yes, please explain: (Program Name & Dates) How many students would you like to mentor? How many students would you like to mentor? One Two Mentors often have a particular set of experiences to share, please help us achieve the best possible match by specifying if you would like to mentor a student from a specific cultural background (if available)? Mentors often have a particular set of experiences to share, please help us achieve the best possible match by specifying if you would like to mentor a student from a specific cultural background (if available)? Yes No If yes, what cultural background? Is there a particular student you would like to mentor? Is there a particular student you would like to mentor? Yes No If yes, name: Why? Are you willing to have the conduct a background check on you, including fingerprints? Are you willing to have the conduct a background check on you, including fingerprints? Yes No Character References List three people (non family members) who can serve as a character references for you. Full Name First Name Last Name Relationship Number of Years Full Address Address Line 1 City Alabama Alaska American Samoa Arizona Arkansas Baker Island California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Jarvis Island Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Maryland Massachusetts Michigan Midway Atoll Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands United States Virgin Islands Utah Vermont Virginia Wake Island Washington West Virginia Wisconsin Wyoming State Zip Full Name First Name Last Name Relationship Number of years Full Address Address Line 1 City Alabama Alaska American Samoa Arizona Arkansas Baker Island California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Jarvis Island Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Maryland Massachusetts Michigan Midway Atoll Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands United States Virgin Islands Utah Vermont Virginia Wake Island Washington West Virginia Wisconsin Wyoming State Zip Full Name First Name Last Name Relationship Number of years Full Address Address Line 1 City Alabama Alaska American Samoa Arizona Arkansas Baker Island California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Jarvis Island Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Maryland Massachusetts Michigan Midway Atoll Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands United States Virgin Islands Utah Vermont Virginia Wake Island Washington West Virginia Wisconsin Wyoming State Zip I certify that the information I have supplied is correct to the best of my knowledge. I grant permission for you to contact the references provided. I also understand and agree to the duties and requirements described in the Volunteer Duties and Requirements. Full Name First Name Last Name Date By using this form you agree with the storage and handling of your data by this website. * I agree