NIRSA Mentor Application

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Thank you for your interest in the NIRSA Mentor/Mentee Program. Please take a few minutes to complete the following information.

Your mentor/mentee match is intended to last one year with the option of continuing that partnership or beginning a new mentor/mentee partnership.

If you have any questions, please contact the Student Leadership Team at nirsa-mentor-program@nirsaleaders.org

"Mentors impact eternity because there is no telling where their influence will stop” -John Maxwell

First Name *

Last Name *

Email Address *

Phone Number *

Institution *

NIRSA Region *

Region I

Region II

Region III

Region IV

Region V

Region VI

Canada

Required

Position/Title *

Program Area *

Current Experience Level *

Undergraduate Student

Graduate Student

Professional with 1-2 years experience

Professional with 3-5 years experience

Professional with 6-10 years experience

Professional with 10+ years experience

Retired Professional

Required

Would you prefer a mentee who oversees similar program/area specialties? *

Yes

No Preference

Required

List 1-3 topics/lessons you hope to learn from this experience. *

Submit

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