2011-2012 BMEN MENTOR APPLICATION
Application Due Friday, March 11, 2011 in HUC 440
University of Alabama at Birmingham
UAB Blazer Male Excellence Network Application
2011-2012
In 2005, two UAB undergraduate male students recognized the need for a program that would address the needs of minority males on this campus. An ensuing ad-hoc committee was formed and in the Fall of 2007, the Blazer Male Excellence Network was founded.
The Blazer Male Excellence Network mentors come from all areas of study and are undergraduate students, graduate students and working professionals.
BMEN Mentors are asked to assist their mentee in making the transition from high school to college and assist them in identifying campus and community resources.
A completed application packet is due on Friday, March 11 by noon and should include the following materials:
- Application
- One recommendation in a sealed envelope (can be delivered with application or the reference can mail the recommendation)
- Response to questions
Please submit the completed packet to the Office of Student Involvement in HUC 440.
Applicants will be notified if they are granted an interview and will sign up between Monday, March 21 and Friday, March 25.
Blazer Male Excellence Network
Mentoring Program
Period of Time Matched: August-May
Qualifications: Currently enrolled UAB student with at least 2 semesters at UAB and GPA of 2.75
Requirements: Attend mandatory Mentor Retreat on August 10, 2011
Attend Mentee Welcome events on August 12-13, 2011
Attend BMEN Match Program & Welcome Ceremony on August 14, 2011
Name ______
LastFirstMiddle
Current Address ______
CityStateZip Code
Telephone Numbers ( ) ____Cell Number ( )
(Current and cell phone)
Permanent Address
(if different from above)
CityStateZip Code
UAB Email Address
Place of Birth
CityStateNation
Date of Birth
Month DayYear
Student ID Number B0
Do you speak other languages? If yes, please specify ______
Shirt Size______
EDUCATION INFORMATION
Expected college graduation date Classification Fall 2011______
Major ______Minor ______UAB GPA
High School Graduation Date: Name & location: ______
References
Please list 2 references that can attest to your character and commitment.
NameTitle/PositionAddressTelephone
NameTitle/PositionAddressTelephone
Campus Involvement:
______
Community Involvement:
______
Special Interests/Talents (i.e. Music, athletics, video gaming, etc.)
______
My signature below indicates that, to the best of my knowledge, the information given on this application is true, complete, and accurate.
Date Signature
Please type and answer the following questions on a separate sheet of paper:
- What role has a mentor played in your success?
- Why should you be selected as a BMEN mentor?
UAB BMEN Recommendation Sheet
Note: The Family Education Rights and Privacy Act of 1974 opens many student records for the student’s inspection. The law also permits the students to waive his/her right to inspect letters of recommendation. The applicant’s signature below constitutes a waiver; no signature means the student will have the right to read this reference.
Applicant’s Signature: ______Date: ______
*if signed, please put in envelope with signature on seal
Name of Applicant: ______
Name of Reference: ______
Relation to Applicant: ______
Please evaluate the applicant in the following areas:
Poor / Below Average / Average / Above Average / Excellent / UncertainTact
Timeliness
Enthusiasm
Commitment to Task
Ability to Accept Direction
Communication Skills
Self Confidence
Personality
Leadership
Ability to Work others
Other Comments:
______
______
Printed Name
______
SignatureDate