MENTOR INFORMATION FORMMENTOR INFORMATION

NAME: DATE OF BIRTH:

COLLEGE ADDRESS:HOME ADDRESS:CELL PHONE: EMAIL:EXPECTED YEAR OF GRADUATION: MAJOR:

Best way to Communicate: Text Email WHICH MENTOR PROGRAM ARE YOU INTERESTED IN?

FITNESS MENTOR SOCIAL MENTORCOMMITMENT: 2-3 FITNESS ACTIVITIES PER WEEK COMMITMENT: 6 HOURS OF SOCIAL INTERACTION PER WEEK

TELL US ABOUT YOU: PLEASE LIST ANY ORGANIZATIONS, CLUBS, OR TEAMS THAT YOU ARE A MEMBER:

WHAT ACTIVITIES DO YOU ENJOY? BASKETBALL CHURCH DRAWING KAYAKING PHOTOGRAPHY SKATEBOARDING WRITING

BASEBALL/SOFTBALL COOKING EQUESTRIAN LACROSSE PING PONG TENNIS YOGA

BADMINTON CRAFTING FOOTBALL MUSEUMS RACQUET BALL THEATER OTHER: BEACH CROSSFIT FRISBEE MUSIC READING VIDEO GAMES BOARD GAMES CREW GOLF MUSICAL INSTRUMENTS RUNNING VOLLEYBALL BOATING DANCING HIKING PADDLE BOARDING SOCCER WALKING

CARD GAMES DISC GOLF HISTORY TOURS PAINTING SWIMMING WATCHING MOVIES

WHAT SPORTS DO YOU LIKE TO WATCH? BASKETBALL FOOTBALL HOCKEY: BASEBALL GOLF OTHER:

WHAT ARE YOUR FAVORITE SPORTS TEAMS:

WHAT TYPE OF MOVIES DO YOU ENJOY? ACTION CHICK FLICKS COMEDY HORROR MYSTERY SUSPENSE ANIMATED CLASSICS DOCUMENTARY MUSICALS SPORTS OTHER:

Property of College of Charleston REACH Program

MENTOR INFORMATION FORMWHAT ARE YOUR FAVORITE MOVIES? WHAT ARE YOUR FAVORITE TV SHOWS?

WHAT TYPE OF MUSIC DO YOU ENJOY?CHRISTIAN ELECTRONIC JAZZ PUNK OTHER:CLASSICAL HIP HOP/RAP MUSICAL R&B/SOUL

COUNTRY INDIE ROCK POP ROCK

WHAT TYPES OF FOOD DO YOU ENJOY?

RELIGION:

SAME RELIGION AS YOUR MENTEE? SAME NO PREFERENCE

I PREFER TO SPEND TIME WITH OTHERS:

IN A GROUP 1 ON 1 NO PREFERENCE

LOUD, ACTIVE PLACES QUIET, MELLOW PLACES

HOW WOULD YOUR FRIENDS DESCRIBE YOUR PERSONALITY?

ANYTHING ELSE YOU WOULD LIKE TO SHARE FOR MAKING A GREAT MENTOR MATCH?(EXPERIENCE WORKING WITH INDIVIDUALS WITH DISABILITIES/MENTORING EXPERIENCE/ REASON FOR PROGRAM INTEREST)

POTENTIAL FITNESS MENTORS ONLY: WHAT IS YOUR IDEAL WORKOUT?

DIRECTIONS FOR SUBMISSIONPLEASE RETURN TO ARIANNE BAUSERMAN, MENTOR COORDINATOR FOR THE REACH PROGRAM: IN PERSON: ROBERT SCOTT SMALL BUILDING, ROOM 135 BY EMAIL: BAUSERMANAM@COFC.EDUMAIN OFFICE: ROBERT SCOTT SMALL BUILDING, ROOM 223 BY EMAIL: REACHPROGRAM@COFC.EDU

REACH OFFICE USE ONLY

RECEIVED DATE:

Property of College of Charleston REACH Program

MENTOR INFORMATION FORMTRAINING/ ASSIGNMENT DATE:

Property of College of Charleston REACH Program