Mentor and Mentee Data Form

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Mentor and Mentee Data Form

Name: ______

Email: ______

Phone (optional): ______

Preferred method of contact (select all that apply): text call Email FAX

Class Standing: FR SO JR SR GRAD

Did you enter UNC Charlotte as an: (AP)2 student freshman transfer student graduate student

Residency: On/Off campus

If off campus: City: ______Zip: ______

Miles from UNCC campus: ______

How many credits have you taken as an undergraduate: ______in physics ______in math ______

How many graduate credits have you received (5000 level or above): ______

How many credits have you received from UNCC (if none, write “none”): ______

Expected degree and graduation date: ______

Status as a physics major: (check only 1)

______primary and only major is in physics

______primary major is physics: Other majors include ______

______secondary major is physics: Primary major is ______

______Considering adding physics as a major: Current major is ______

Minor(s):______

List interests you are passionate about or like a lot outside of physics that you wish to share (optional)

______

What career do you envision being happy doing? (List as many as you can in the space provided)

______

What do you hope to gain by participating in this peer mentoring program?

______

For mentors only: Answer the following questions:

(optional) What is your overall GPA ______GPA in physics ______GPA in math ______

______On a scale from 0 to 10, (0 hate it, 10 love it) rank how much you like writing lab reports.

______On a scale from 0 to 10, (0 hate it, 10 love it) rank how much you like asking questions.

______On a scale from 0 to 10, (0 never, 10 always) rank how often you tend to draw pictures to solve a physics or math problem.

______On a scale from 0 to 10, (0 never, 10 always) rank how often you prefer to write out steps to solve problems versus doing the steps in your head?

Check all that apply:

______I have written more than 6 lab reports in a lab setting or classroom setting.

______I have research experience(s)

Circle all that apply: CRS REU Honors Thesis Capstone project senior design other

List research topic, where the research was performed, in what program and your supervisor: ______

______I have presented research in a public forum as a poster or presentation.

List all places this was done and describe the event succinctly

______

Answer yes or no for the following questions.

______I have written at least 1 final report or thesis or term paper (1 of which was at least 10 pages with at least 8 references) on my research results.

______If you could, would you do anything differently as an undergraduate knowing what you know now?

______Have you ever been personally mentored before by a peer in Physics or in College?

______Have you ever been personally mentored before by a professor?

______Do you seek to take on leadership tasks and/or be willing to train to become a future leader?