Online Survey Software | Qualtrics Survey Solutions

Hello UNT Dallas faculty and staff,

Thank you for investing your time, talent and life experience to our first-generation college students. By completing this form, you are agreeing to the program responsibilities of a Trailblazer Elite Mentor. As a mentor, you will meet with your mentee twice a month, attend monthly mentor check-in meetings, document student progress, and communicate with the program supervisor. In the event you can no longer fulfill these commitments, you will notify Dr. Hodge immediately.

Thank you again for your willingness to make a difference!

The Trailblazer “ELITE” Team

First Name:

Last Name:

Employee ID#:

Email:

Commit to mentor

1 mentee
2 mentees

List your contact phone number. (Please note: This will only be shared with TBE Professional Staff.)

List your address. (Please note: This will only be shared with TBE Professional Staff.)

List your preferred method(s) of communication. Check all that apply.

List your unisex shirt size.

List your current role.