GOLD Mentor Form

Mentor's Information

Please provide the following information about yourself as the mentor:

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Your first and last name:

Your position/title:

Your phone number:

Your DU email address:

Email address must be of a valid format.

Student (Mentee) Information

Please use the following fields to provide information about the student (mentee) with whom you worked:

Student Name

ID Number

DU Email address

Information Needed from Mentor

Please address all of the following questions/issues in the space provided below:

Please indicate the date of your 1st meeting with your mentee.(Required)

This field is required.

Please indicate the date of your 2nd meeting with your mentee.(Required)

This field is required.

Please indicate the date of your 3rd meeting with your mentee.(Required)

This field is required.

Please indicate the date of your 4th meeting with your mentee.(Required)

This field is required.

Please indicate the date(s) of any additional mentor meetings that have occurred. This field is required.

Please describe this student's level of engagement in conversations regarding their prior behavior which was contrary to the University's expectations and values.(Required) This field is required.

Please describe this student's plan for making modifications to their decision making moving forward.(Required) This field is required.

Do you have any additional comments? Please explain. This field is required.

Supporting Documentation

Please attach any supporting documentation you want to provide. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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Mentor's Information

Student (Mentee) Information

Information Needed from Mentor

Supporting Documentation

Submission