Class2Class Program - Form - Norwich University

Mentor Intake Form

Please complete the following:

Your Information

First Name: *

Middle Name:

Last Name: *

Nickname:

Maiden Name:

Your Connection to Norwich: *

Phone Number: *

Email: *

Address Line 1: *

Address Line 2: *

City: *

State: *

Zip Code: *

Highest Level of Education: *

Institution: *

Graduation Year:

Work Information

Employment Status: *

Current Company: *

Current Job Title: *

Are you already involved in any of the following mentoring initiatives? Please check all that apply:

I am not participating in any mentoring initiatives

Accepting the Charge (through the NUAA)

College of Liberal Arts Mentoring (CoLA Board of Fellows)

GUIDE Mentoring (Faculty/ Staff to Student)

*

Mentoring Information

Why are you interested in becoming a mentor?*

What is your weekly or monthly availability? (examples: 1 time a week, 2-3 times a month, etc.)*

How long will you be available for each contact? (indicate in minutes)*

Maximum number of protégés?*

Verification Information

I have read and understand How C2C Works and the Mentors sections on the C2C Landing page.*

I give the Class2Class Program permission to use the information submitted to activate my Handshake account.*

Mentor Showcase

A series of digital promotions directed to students as a means to promote the Class2Class program. The digital promotion will include: photo, first and last name, current employer, past employers, areas of expertise and a quote about why you are interested in becoming a mentor.

I give the Class2Class Program permission to use my intake form and Handshake profile information for the Mentor Showcase.*

List your areas of expertise that you'd like to share.

Norwich University | Alumni & Family

the class-2-class program

Mentor Intake Form

Please complete the following: