Name: _____________________________________________________________________ Date: ____________________

Department: _________________________________________________________ Location: ______________________

Current Classification/Position: __________________________________________________________________________

Work Phone: _____________________ Home Phone: ______________________ E-mail: _________________________

How did you hear about the Mentoring Program? ___________________________________________________________

Supervisor’s Name: ____________________________________________ Supervisor’s Phone: _____________________

Supervisor’s Signature: _________________________________________________________________________________(Supervisor: You will be receiving a Supervisor Assessment Form via e-mail to complete for this applicant.)

Please choose one of the following areas in which you would like to be mentored:

□ Accounting□ Administrative Services□ Dining, Catering & Advanced Culinary Skills□ Guest Relations & Building Operations□ Housekeeping Services

□ Human Resources□ Maintenance Services □ Residential Life□ Sales, Marketing & Customer Service

Please answer the following questions as completely and thoroughly as possible. If necessary, use additional sheets to complete your answers.

1) What are your career goals within Housing & Hospitality Services?

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2) How do you think the Mentoring Program can help you reach your goals?

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__________________________________________________________________________________________________(continued on reverse side)

2010-2011H&HS MENtORiNG PROGRAM APPLiCAtiON fORM

ApplicAtion DeADline: August 6, 2010

Your APPlIcAtIon should Include thIs comPleted form And Your current résumé, If You hAve one.

3) What are your best personal and professional qualities?

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4) What skills do you want to improve upon?

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5) Describe what you have done to improve your skills, including school, training, professional associations, volunteer work, community service, or other activities.

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6) How will your joining this program make you a better team member in H&HS?

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PLEASE SuBMit yOuR COMPLEtED H&HS MENtORiNG PROGRAM APPLiCAtiON by Friday, august 6, 2010 tO: uCLA H&HS Mentoring Program Angela Marciano, Mentoring Program Coordinator and Director Organizational Planning, Performance & Development, Housing Administration Campus Mail Code: 136707 360 De Neve Drive Los Angeles, CA 90095-1367

yOu WiLL BE CONtACtED By SEPtEMBER 1, 2010 REGARDiNG tHE StAtuS Of yOuR APPLiCAtiON.

if yOu HAvE ANy quEStiONS ABOut tHE H&HS MENtORiNG PROGRAM BEfORE yOu SuBMit yOuR APPLiCAtiON, PLEASE CONtACt ANGELA MARCiANO At (310) 206-4455 OR AMARCiANO@HA.uCLA.EDu.

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