2011-2012 Bmen Mentor Application

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:

1. Application
2. One recommendation in a sealed envelope (can be delivered with application or the reference can mail the recommendation)
3. 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:

1. What role has a mentor played in your success?

1. 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:

Other Comments:

______

______

Printed Name

______

SignatureDate