First Name: Last Name: Student ID #

Mailing Address: Apt. #
City: Zip:

Home phone:    Work phone:

E-mail address:

I am applying to be: Mentor      Mentee

Have you participated in the Odyssey Program before? Yes    No     If yes, when?

Current classification as a student: High School Senior Freshman Sophomore Junior Senior Grad student Graduate studies College/Technical School

Statistical Data:
Birth date: Gender: Female Male Ethnic Origin: Caucasian Black Hispanic Asian American Indian Multi-Racial Other

Degree Major: Minor:
How did you learn about Odyssey?
What is your primary motivation for joining the Odyssey Peer Mentoring Program? Social Academic Acclimate to KSU Same academic major
Do you speak any foreign languages? Please identify:
Tell us about your talents/hobbies:

Peer Mentoring area in which I am most interested.
Please indicate 1st, 2nd, and 3rd choices.
1st choice Adult Learner Program (age 25+) disAbled Student Services International Student Services Minority Student Services Traditional student
2nd choice Adult Learner Program (age 25+) disAbled Student Services International Student Services Minority Student Services Traditional student
3rd choice Adult Learner Programs (age 25+) disAbled Student Services International Student Services Minority Student Services Traditional student

Please check all of the following items that best describe you and that you are comfortable answering. This information will be used for purposes of matching you with an individual in the peer mentor/mentee relationship. This information will be utilized only by the advisor of the peer mentor/mentee population you have chosen and will not become public.

Marital status: Married Single Divorced Widowed      Children: (ages/gender)     
Country of origin (other than USA)
Current status: New freshman    Second semester freshman     Transfer student from:
Current group: Traditional aged student (under 25)       Non-traditional aged student (over 25)

Interests:

Music (types)
Movies/Films (types)   
Travel   
Video games
Cultural activities     
Reading (types)
Volunteer Work
Shopping
Photography
Animals/pets
Dancing
Outdoor activities
Computers (any specifics)     
Spiritual/religious activities     
Community service activities     
Writing (any specifics)     
Cooking
Arts & Crafts
Scouting     
Sports (participant)     
Sports (observer)
Other interests

When would you be available to meet with your mentor/mentee (be as specific as possible including day of the week, times of day, and when you are on campus for classes)