Nuturing Initiative & Achievement (NIA) Mentor Program

"It Takes a Villiage to Raise a Child" - African Proverb

Online Faculty/Staff Mentor Application

Minority Student Services
Buffalo State College
Campbell Student Union, Suite 400
(716) 878-4631

Read: "What does it mean to be a faculty/staff mentor?"

Directions: Please fill out this form completely to ensure the best possible match. Thank you.
Full Name: Title: Email Address:  
Campus Address: Campus Phone:  
Home Address: Home Phone:


Male Female  

Do you work with or advise any organizations on campus? Yes No If yes, please list them here:


Have you resided in an urban environment or attend school in one?

Yes No    
What is your mentee preference? No preference Male Female  
How many hours a week can you mentor? 1-2 3-5 5-7 7-10
Please answer the following questions as thoroughly as possible. The more elaborate you are, the easier it will be to find a good match. Thank you.
Why do you want to be a Mentor?
What would you like your mentee to gain from this experience?
Please list your interests and hobbies:


If you have any comments, concerns or questions, please contact us at the Minority Student Services office, suite 400 of the Campbell Student Union, (716) 878-4631. If you are experiencing technical difficulties with this form or would like one mailed to you, please email us.

March 2004