Puente Project Mentor Profile Form Thank you for your interest in being an ACC Puente Mentor! Please complete the following information and submit to: Alejandra Polcik Puente Project Coordinator ACC Highland Business Center, Rm-609.1 5930 Middle Fiskville Road Austin, TX. 78752 Ph: 512.223.7953 Fax: 512.223.7956 E-mail: [email protected] http://www.austincc.edu/degrees-and-certificates/earn-a-degree-and-transfer/puente

Personal Information: Name: _______________________________________ Ph # (___) ___________ Email: _______________________________________ Address: _____________________________________________________________________________ Current Employer: ______________________________________ Current Position: _________________ Employer Address: _____________________________________ Business Phone# (___) ________ Description of Responsibilities:

Please describe any special hobbies or interests you may have:

Are you affiliated with any cultural, community or civic organization? o o

No Yes…… If yes, which one(s)?

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Do you speak Spanish? o o

No Yes…..If yes… Fluently or Limited?

Are you affiliated with any professional associations? o o

No Yes……. If yes, which one(s)?

Educational Information (Check all that apply): Associate’s Degree

Major:_____________________

College:________________________

Bachelor’s Degree

Major:_____________________

University:_____________________

Master’s Degree

Major: ____________________

University:_____________________

Doctorate Degree

Major:____________________

University:_____________________

Are you a first –generation college graduate? o No o Yes Did you receive financial aid as a college student? o No o Yes Did you have to work while attending college? o No o Yes

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Miscellaneous Information: Do you have previous experience(s) mentoring students/youth? o No o Yes…. If yes, please describe under what capacity? When? Where? How long? What age group?

Who was an important mentor for you and why?

What interests you about being an ACC Puente Mentor?

Thank you for your interest to become an ACC Puente Mentor!

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