KAA Mentorship Mentee Application (2014-2015)
Overview

The Khmer Alumni Association Mentorship Program pairs up a mentee with a mentor from January to June 2015. Throughout this relationship, mentoring will be provided via remote access, at least once a month to discuss any questions, comments, or concerns regarding academics, career choices, or any life decisions.


Purpose

The purpose of KAA ‘s Mentorship Program is to provide one-on-one guidance and support for Cambodian students. By doing so, KAA aims to promote enriching knowledge, professional development, experience and relationships that will help empower Cambodian students to succeed in their academic/career success, individual goals and lives thereafter.


Mentors and Mentees

Mentors are members of the Khmer Alumni Association who have filled out an application. After completing the application, the committee leads will notify mentors and have them go through a training session. Mentees are students who have filled out an application, which includes a parent/guardian consent form. Upon submitting the application, a screening process will take place and a selected group of mentees will be invited to attend orientation. Afterwards, the committee leads will notify mentees and mentors of their pairing beginning January 17.


Any student may apply to be a KAA Mentorship Mentee, if you:

Are a current full-time student
Between the ages of 14-19 years old
Cambodian (at least 1 parent must be of Cambodian descent)
Minimum cumulative 2.0 G.P.A.
Internet access and computer with built-in camera
Complete and submit KAA Mentorship Program Mentee Application
by January 23
Complete and submit informed consent from a parent/guardian
by January 24
Attend 1 Orientation Day on
Saturday, January 24

Name *
First and Last name format
Your answer
Gender *
Required
Address *
Street, City/Town, Zip Code
Your answer
Home Phone Number *
Your answer
Cell Phone Number
Your answer
Birthdate *
MM/DD/YY format
Your answer
E-Mail
Your answer
Age *
Your answer
Grade Level *
Your answer
Parent/Guardian Name *
First and last name
Your answer
Parent/Guardian Relationship *
Your answer
What language(s) do you speak? *
Your answer
School Name *
Your answer
Favorite Subject *
Your answer
LEAST Favorite Subject *
Your answer
What activities, sports, clubs, etc. are you involved in? *
Your answer
I would describe myself as... *
Please choose three
Required
List a few jobs/professions you've been thinking about for yourself. *
Your answer
Please tell us what you hope to gain from this mentorship program. *
For example: build new relationships, learn what to expect in college, how to do better in school, explore new careers, gain new career/college goals
Your answer
What do you want to learn from your mentor? *
Your answer
What do you like to do the most in your free time? *
(Check all that apply and give examples of your favorites)
Required
Please introduce yourself to your mentor by writing a little bit about yourself. You can start by telling them your name, how old you are, where you live and what you expect to gain from this experience. Also let them know what your plans are after high school, what college or university you’d like to attend and why, as well as how you plan to prepare yourself to meet your goal. We will share this information with your mentor. *
Your answer
Which day will you be available to attend Orientation?
(Please choose one date)
How did you learn about KAA Mentorship Program?
For example: friends, social media, website, event
Your answer
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