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OFFICE OF DIVERSITY AND INCLUSION

Multicultural Student Mentoring Program

Mentee Application

 
Expectations of MSMP Mentee participants:
  • Engage with your assigned MSMP Mentor
  • Attend at least two campus events with your MSMP Mentor
  • Complete ten (10) hours of community service
  • Meet once a month with the Office of Diversity and Inclusion
  • Maintain a minimum 2.50 GPA

Registration Information

Admit Term:
Fall 2018

First Name:

Last Name:

Gender:

Pronoun (her, him, hir, zir, etc.):

myWSU ID:

Date of Birth:
MM-DD-YYYY

Mailing Address:

City:

State:

Zip Code:

Do you live:
On-campus
Off-campus
Home with Family

If you live on-campus, which residence hall do you reside in?

Mailbox #:

Phone:
(XXX) XXX-XXXX

Email:

WSU Email:

Classification:
Freshman (1-29)
Sophomore (30-59)
Junior (60-89)
Senior (90+)

Are you a transfer student? Yes No

Number of hours transferring?

Transfer Institution:

Major:

Minor:

Briefly answer the following questions below:

Career Interest:

Did you earn college credits while in high school? Yes No

GPA:

Number of credit hours earned in high school:

Personality: (Mark all that apply)
Shy
Outgoing
Reserved
Aggressive
Talkative

Are you a U.S. citizen/permanent resident? Yes No

If no, what country are you from?

Are you Hispanic or Latino? Yes No

Race:
Asian
Black/African-American
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
White/Caucasian
Other

Have you ever been placed on academic probation before? Yes No

If yes, please indicate which semester(s):

Are you a first generation college student? Yes No

What academic areas are challenging for you?

What expectations do you have for your MSMP Mentor?

Please list your special interests/hobbies:

What clubs/organizations are you interested in at Wichita State?

How did you hear about MSMP? (Mark all that apply)
 

Mailing ODI Website Email
Orientation Word of Mouth Informational Table
Facebook Twitter Instagram
High School Counselor Other

 


Release of Information

I hereby waive protections provided by the Family Education Rights and Privacy Act of 1974 and authorize WSU faculty and administrators to share my education records and/or provide information regarding my education records and/or academic performance at WSU with a delegate in the Office of Diversity and Inclusion, may review my academic status/progress at WSU for the purpose of assisting me in achieving academic success.

I understand that by checking "accept" and providing a digital signature below, the Office of Diversity and Inclusion, with my consent and authorization, will periodically review my education records and follow-up with me to discuss my academic progress/performance at WSU. This waiver shall remain in effect until revoked or withdrawn by me in writing.

By checking "accept" and digitally signing my full name, I have acknowledged and certified that I have read the "Release of Information" and I am giving consent and authorization for the Office of Diversity and Inclusion to periodically review my education records.
Accept

Digitally sign your name below:

Notice of Nondiscrimination

Please review policy 3.02 / Notice of Nondiscrimination in Wichita State University's Policy and Procedures manual.