Mentor Application

To complete and submit this application, either (1) copy/paste the document in an email to Leigh Ann Thomason (lathomas@ncsu.edu) and complete the application in the email window; (2) complete and return a paper copy available in 202 Patterson Hall on NC State University's campus or (3) complete a paper copy and return to:

Leigh Ann Thomason
3201 Compatible Way Apt #302 D
Raleigh, NC 27603

 

The NC State Statistics Professional Mentoring Program is an opportunity for students to develop their professional skills outside of the classroom through the guidance of a professional in the community. It is also a great way for alumni and friends to connect with the college as well as current and future professionals in their field. Please read the below expectations to determine if you will be able to make the necessary commitments needed to make the mentoring relationship a success.


1. Attend the Orientation Kick-Off event in September.
2. If it is not possible to attend the Orientation Kick-Off event, arrange for a one-on-one meeting with your student as early as possible in the program to establish goals the student would like to achieve.
3. Maintain regular contact with your student via phone, email and/or meetings and meet your student at least once a month or as determined by goals set together at orientation.
4. Complete program evaluations when appropriate.
5. Contact the Professional Mentoring Program Coordinator, Kristin Chaudoir, if circumstances require you to stop participation in the mentor program or if your student is not fulfilling his/her responsibilities.

By completing the form, I am indicating my willingness to participate as a mentor in the Statistics Professional Mentoring Program. I have read the above expectations and understand my responsibilities as a participant in the program. I am also aware that mentors are matched with students based on requests made on the student applications. I understand that I will be contacted in the fall if I have been matched with a student. If I am matched, I will receive information about my student prior to the Orientation Kick-Off and will make my initial contact with the student at the Kick-Off, if I am able to attend. (The student will be informed of the match at the Kick-Off.)

If you agree to these terms, please continue to complete the application.

First Name:

Last Name:

Home Address (only for internal use):

City:

State:

ZIP:

Home Phone:

Email:

 

Company Name:

Company Address:

City:

State:

ZIP:

Company Phone:

Company Fax:

Description of Business:

Title:

Briefly describe your primary job responsibilities in your current position.


Degree(s) Received and Major/Emphasis:

University(s) and Year(s):

Other information (other areas of expertise, special interests, etc.):


Have you previously participated in the Statistics Professional Mentoring Program?


If yes, do you prefer to be matched with your previous student?
 

Previous student’s name:



Indicate your preference for a student’s current education level (please put X next to all that apply):
Freshman
Sophomore
Junior
Senior
Master’s student
PhD student

Would you be interested in mentoring more than one student?