Name *

Email *

Student ID# *

PO Box *

Phone *

Class *

Name of your hometown *

City, State *

Name of your high school *

Describe your high school (what type of school and what was your experience as a student?): *

Briefly describe your academic interests. Include the name of your major/minor, if known. *

Extracurricular, Personal, and Volunteer Activities:
List your most important extracurricular activities in the order of their importance to you. These can include high school, MHC, or community activities such as athletic teams, newspaper, internships, volunteer work, or singing groups.

Work Experience: List any jobs you have held during the past three years.

Why do you want to be a Leadership Mentor? *

What do you hope to gain from your experience as a Leadership Mentor? *

What strengths will you bring to your position as a Leadership Mentor? *

In what ways do you think you will be challenged as a Leadership Mentor? *

On-campus references (one must be from a MHC faculty member):

By signing below, you indicate that you have read through the attached materials and understand your obligation as a Leadership Mentor, to both the Weissman Center for Leadership and the Take the Lead Program. Please review the commitments below and check to indicate your agreement.