NAFSA

Region XII

MENTOR/MENTEE PROGRAM APPLICATION

APPLICATION INFORMATION q Mentee Applicant q Mentor Applicant

Last Name: First Name: Title:

NAFSA Membership ID#(see instructions if not available):

Institution /Organization/ School District:

Mailing Address:

 

 

Telephone: Fax: e-mail:

 

NAFSA Knowledge Community: (You may select one, or more than one.)

  • Education Abroad
  • International Education Leadership
  • International Student and Scholar Services
  • Recruitment, Admissions and Preparation
  • Teaching, Learning and Scholarship

 

Number of months or years in international education:

 

______________ years ______________ months

MENTEE APPLICANTS:

If there is a current NAFSA member at your institution, please identify:

Name: ___________________________________________________

 

Do you have access to NAFSA resources through this member? q Yes q No

 

 

Signature of Applicant: ______________________________ Date: ______________________

 

ADDITIONAL REQUIREMENTS:

 

MENTOR AND MENTEE APPLICANTS: Please include a letter describing your interest in participating in the Region XII Mentoring Program.

 

MENTEE APPLICANTS: In your letter, please list three to five goals that you hope to accomplish with the support of your Mentor during your participation in the Mentoring Program.

 

MENTOR APPLICANTS: If you are retired or not a current NAFSA member, please include a letter of recommendation from a current NAFSA member.

 

Please submit application and supporting materials to:

 

Denise Kinsella

International Student Program

Long Beach City College

4901 E. Carson St.

Long Beach, CA 90808

 

All application materials must be postmarked no later than OCTOBER 15, 2008