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MassBay Business Mentor Participation Form

MassBay Business Mentoring Program

Mentor Participation Form

Thanks for wanting to serve as an individual mentor to a MassBay student.

1. Name: *This question is required.

First Name
Last Name

2. Preferred address: *This question is required.

Address
City
Zip-code

3. Preferred email: *This question is required. This question requires a valid email address.

4. Preferred phone:

5. Gender identity:

Please enter an 'other' value for this selection.

6. Languages:

Space Cell	Native	Good	Intermediate	Beginner
English	English : Native	English : Good	English : Intermediate	English : Beginner
Spanish	Spanish: Native	Spanish: Good	Spanish: Intermediate	Spanish: Beginner
French	French: Native	French: Good	French: Intermediate	French: Beginner
Creole	Creole: Native	Creole: Good	Creole: Intermediate	Creole: Beginner
Chinese	Chinese: Native	Chinese: Good	Chinese: Intermediate	Chinese: Beginner
Italian	Italian: Native	Italian: Good	Italian: Intermediate	Italian: Beginner
Russian	Russian: Native	Russian: Good	Russian: Intermediate	Russian: Beginner
Vietnamese	Vietnamese: Native	Vietnamese: Good	Vietnamese: Intermediate	Vietnamese: Beginner
Tagalog	Tagalog: Native	Tagalog: Good	Tagalog: Intermediate	Tagalog: Beginner
Arabic	Arabic: Native	Arabic: Good	Arabic: Intermediate	Arabic: Beginner
Enter another option	Other: Native	Other: Good	Other: Intermediate	Other: Beginner
Enter another option	Other: Native	Other: Good	Other: Intermediate	Other: Beginner

WORK INFORMATION

7. What is your last Degree/Major? *This question is required.

8. Recent or last job title:

9. Name of last employer:

10. How long have you been or were employed in your field?

11. What are/were your main job duties?

12. What do you consider your primary and secondary areas of expertise?

13. Optional: Please insert a brief professional bio below

14. Optional: Distinctions, Honors, Awards, and Other Recognition of Achievement

EDUCATIONAL BACKGROUND

15. Are you the first in your family to graduate with a college degree?

16. Have you ever attended community college?

17. If you answered "yes" to the question above, which community college did you attend?

18. Have you ever transferred from one academic institution to another?

PROGRAM PARTICIPATION

19. In which activities would you like to participate with your mentee? (Please check all that apply).

20. What are your preferred meeting locations? Please check all that apply

Your place of work
MassBay Framingham Campus Cafe
MassBay Wellesley Hills Campus Cafe
Other, please specify: Please enter an 'other' value for this selection.

21. Can you commit to dedicating at least 10 hours a semester to meeting with your mentee/s?

22. Are you willing to mentor more than one mentee? *This question is required.

23. If you answered "yes" to the question above, how many mentees are you willing to mentor?

24. What is your general availability for meeting your mentee? (select all that apply)

Business hours
Evenings
Weekends

25. How can MassBay Community College best support you as a mentor?