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Please complete the following form to register as a mentor for the Civic Learning Program.

NOTE: The contact information you provide will be given to the student to make their initial contact with you. If you have one number you'd like us to use and another to give to students, please indicate that information on the form below.

Phone Number:
E-mail Address:
E-mail must end in OR

Describe yourself (i.e. personality traits, characteristics):

How would your best friend describe you?

Describe your hometown:

Explain your professional experiences, knowledge, skills and abilities:

What brought you to JMU and/or Harrisonburg?

What involvements or connections do you have in the Harrisonburg community?

How informed are you about campus resources for students? What particular areas are you most knowledgeable about?

What are your hobbies, interests, or passions? What do you like to do in your free time?

What type of student do you think you would work best with?

What type of student do you think you would NOT work best with?

Why did you become a Civic Learning Mentor?

Please include any additional information we would need to know about your availability to take a student.  Are there any times of the year you would prefer not to be assigned a student?

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