Mentee Intake Form

Gathers each incoming student's studies, career goals, interests and availability for the mentoring program. Helps the mentor know their mentee from the first meeting and offer better support.

Use this template

In the Claude connectors directory

Date

Time

Full legal name

Student ID number

Preferred phone number

Preferred email

What is your major?

If undecided, which majors are you considering?

What is your career goal?

If undecided, which careers are you considering?

Which courses are you taking this semester?

Which subjects do you enjoy studying?

Which subjects have been challenging for you?

Have you ever used academic tutoring?

Yes, on campus Yes, private tutoring Yes, online No, never

Were you born in this country?

What language(s) do you speak at home?

Are you a first-generation college student?

What would you like your mentor to know about you? For example, your values, qualities, achievements or special skills.

What are your hobbies and interests?

What might get in the way of your academic progress? (e.g. job, family needs, housing, child care)

Which services, resources or benefits do you think you might use this year?

Tutoring Counseling Career services Financial aid Health services Food or housing support

There are several ways to keep in touch weekly with your mentor. Which work best for you? (Check all that apply)

Student signature: by joining as a mentee I agree to meet my mentor monthly, keep in touch weekly and take part in at least 3 program activities.

Sign here

Date

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