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Mentee Submission Form

Please fill out the below information if you wish to be connected with a mentor through the PAGE Center. The information below is confidential and will only be utilized to connect you with someone that fits well with what you are seeking in a mentor. While answering all questions will make it more possible to provide the best fit between mentor and mentee, the only questions that are required are name, student ID, and email. At the end of the form are three statements of consent and agreement that we require you to affirm if you wish to participate in the program. The remainder can be left blank if desired.

Mentee Submission Form

What year are you in school? (If you are a transfer student, please select transfer student and the year.)
In submitting this form, I consent to the Pride Center staff having access to my answers in order to match me with a well fitting mentor. I consent to the Pride Center using my demographic data (e.g. gender, race, ethnicity, sexual orientation) to assess who is using the center, with the understanding that this data will be disconnected from my name, email, student ID and anything else that could identify who I am to others. I consent to the Pride Center emailing me in order to arrange a time to meet with the Pride Center director and my potential mentor.
I understand that this program is meant to be utilized as a way for students to further their identity, academic, and professional development and to foster holistic growth. I understand that this program is not meant to be used for romantic/sexual purposes. I understand that my mentor and I will agree upon set boundaries around when and where we meet and what we discuss and that violating those boundaries will be considered an abuse of the mentoring program. I understand that mentor/mentee program participation can end if the Pride Center staff feel that the program is being abused or are alerted to anything unsafe occurring.
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Contact the PAGE Center

CUB 232 1871 Old Main Drive, Shippensburg, PA 17257 Phone: 717-477-1291