Mentor Application

Name*

First Middle Last

ACADEMIC RANK*

ACADEMIC DEPARTMENT*

OFFICE MAILING ADDRESS*

Street Address Address Line 2 City State ZIP Code

OFFICE PHONE*

OFFICE FAX NUMBER

HOME ADDRESS*

Street Address Address Line 2 City State ZIP Code

HOME PHONE*

HOME FAX

Email*

Enter Email Confirm Email

HAVE YOU PREVIOUSLY SERVED AS A UNCF/MELLON MENTOR?*

Yes
No

If YES, PLEASE PROVIDE THE NAME(S) OF THE STUDENT(S) YOU MENTORED.

Please describe your interest in serving as a UNCF/Mellon Mays Undergraduate Fellows’ Mentor and how the student’s research interest compliments your areas of scholarship. Please also describe how you will structure your interactions (i.e., independent study, weekly meetings, etc.) with the fellow. Please also speak to the student’s character traits that you believe will sustain him or her as a representation of your institution and the UNCF/Mellon programs.

PLEASE ATTACH YOUR MENTOR’S STATEMENT TO THIS FORM*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 32 MB.

NAME OF APPLICANT WHOM YOU WILL MENTOR

I HAVE READ THE RESPONSIBILITIES ASSIGNED TO A UNCF/MELLON MENTOR AND I AM PREPARED TO SERVE IN THIS CAPACITY. I HAVE PROOFREAD THIS NOMINEE’S PERSONAL STATEMENTS (RESEARCH AND CHARACTER STATEMENTS) AND APPROVE OF THEM FOR SUBMISSION WITH THEIR APPLICATION.

SIGNATURE OF MENTOR*

First Last

Date

Please attach an abbreviated curriculum vita (NO MORE THAN TWO PAGES)*

Accepted file types: doc, docx, pdf, Max. file size: 32 MB.

MENTOR APPLICATION

MMUF

FCE

Applications