KSURF Virtual University: Mentor Questionnaire

Mentor Questionnaire

My Name:

My Hometown (City, State, Country):

My Birthday (month and day only, not the year!):

My Email Address:

My Personal Website URL: (optional)

My Blog URL: (optional)

My Facebook page: (optional)

My Photograph: (URL of a small photo for your profile)

My areas of interest or expertise:

My qualifications and experience (employment, degrees, training, etc.):

Awards, Honors, Certificates:

Why I want to be a Knowledge Web Mentor:

My Introduction (about 200 words introducing yourself to students)
TIP: The box below is designed to accommodate approximately 200 words.

By submitting this application, you acknowledge that you have reviewed and will adhere to our policies on Copyright Infringement and Plagiarism and our general Terms of Service.