Pilipinos for Community Health Mentorship Program - Mentee Application
Dear potential mentee,

Thank you for your interest in becoming a mentee for the Pilipinos for Community Health Mentorship Program! In this program you will be paired with a mentor (an upperclassman at UCLA who is at least a year older than you) who shares the same career goal as you. If you don’t have a set career goal yet, don’t worry! You can be paired with an upperclassman who is also undecided, but is well versed in how to explore career interests. This program was created to give you an extra support system to help you with your career aspirations and academics at UCLA. To ensure that you and your mentor have a successful relationship, please take the time to read the mentee expectations before filling out this application found here:

https://docs.google.com/document/d/17DxFZphurAG0xHsnXhE59jdur8yXJrTTrr-b2fJIeUg/edit

Thank you!
Basic Information
This is basic information we need to know about you!
Name *
First & Last
Your answer
Major (s) *
Your answer
Minor (s)
If applicable
Your answer
Year *
Are you a transfer? *
If you are a transfer, would you like to be pair with another transfer?
If you are not a transfer, please leave this question blank.
Email *
Your answer
Cell Phone # *
FORMAT: xxx-xxx-xxx
Your answer
Texting OK? *
Preferred Mode of Communication *
Birthday *
FORMAT: mm/dd/yyyy e.g. 09/21/1992
Your answer
Hometown *
Your answer
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