Office of Academic Affairs - Mentoring Program -Become a Student Mentee

Hostos Community College Mentoring Program
Student Information Form

Mentee Online Registration
Please fill in all fields and click on "Submit" button

Title:	First Name * :	Last Name * :	Suffix:
Phone Number * :		Cell Phone Number :
Your E-mail Address *(ie. name@domain.com):
Please indicate if you have a Hostos Mentor:
Mentee Status : Have a Hostos Mentor Need a Hostos Mentor
If you have a Hostos Mentor, please indicate who s/he is, and their department:
First Name:	Last Name:	Department:
Please indicate department preference of Mentor: (Please note: Preferences are not guaranteed)
Department:
Please describe some academic areas of interest:
Enter text here
Describe some of your hobbies:
Enter text here
Please describe some academic goals:
Enter text here
Please indicate the days that you are available on campus to meet with a mentor. (Check all that apply). Mentoring takes a minimum of one hour per week to visit with your mentor.
Monday	am	pm
Tuesday	am	pm
Wednesday	am	pm
Thursday	am	pm
Friday	am	pm

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