Black American Council Mentee Application

* fields are required

In order to receive member benefits and be accepted into the Black American Council (BAC) Mentoring Program you must be currently enrolled in a class at Tri-C.

College Credit Plus (CCP) Students are not eligible for the BAC Mentoring Program.

First Name: *

Last Name: *

ID Number (S1234567 Format): *

Address 1:

Address 2:

City:

State:

Zip Code(00000 format):

Phone (Home): *

Phone (Cell):

Email Address: *

Gender:

Major(s)/Field(s) of Study:

Which campus do you attend for most of your classes?:

Please name an African-American employee at Tri-C whom you would like to have as a mentor

Mentor Name:

MENTEE AGREEMENT

The Cuyahoga Community College Black American Council Mentoring Program will provide each mentee with a caring mentor, information about academic support services and an environment that fosters academic success.

I agree to the following responsibilities and expectations:

Maintain contact with your mentor by phone, email or in person.
Meet with my mentor at least once each semester.
Permit your mentor to monitor your academic progress.
Contact your mentor prior to withdrawing from a class.

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