First (Preferred) Name *

Last Name *

MIT ID *

Role at MIT *

Department *

Campus Address *

Campus Phone

MIT Email *

Are you currently a First-Year Advisor? *

Are you a returning MAP mentor? *

If applicable, check the academic years you have previously participated as a MAP mentor

Undergraduate Institution *

Graduate Institution

Area of undergraduate study *

Area of graduate study

Do you have research experience/area of interest? *

If yes, please specify area/topic

These next two questions are optional to answer. These questions help us with the matching process along with end of year reporting.

Gender:

My gender is:

Are you transgender:

Race/Ethnicity (select all that apply) *

Asian Middle-Eastern Black / African-American / Caribbean-American / African Hispanic / LatinX Native American / American Indian / Native Alaskan / Pacific Islander White / Caucasian / European Another racial identity Choose not to respond

If another, please specify:

Religious affiliation (select all that apply) *

If another, please specify:

Hometown City:

Hometown State:

If you speak a language other than English, please include it here:

Arts (visual, performing, craft, culinary, etc.):

Sports:

Music (genre, listen, play, produce):

Play musical instruments:

Outdoor Activities (hiking, camping, etc.):

Computers (programming, hacking, etc.):

Games (board, video, etc.):

Literary Arts (reading):

Social:

Other:

Please indicate which of these identities apply to you, if any:

First Generation (those whose parents' highest level of education is a high school diploma or less) Low Income (an individual whose family's taxable income for the preceding year did not exceed 150 percent of the poverty level amount) Person with a disability LGBTQIA+

A conversation starter for me would be... (List 3 broad topics [e.g., politics, sports, media,etc.]) *

Please provide a 3-5 sentence bio. Include information about your role at MIT and other interests that would help a potential protégé get to know you. *

Matching Preferences Grid *

1 -

2 -

3 -

4 -

5 -

How many protégés would you like to mentor? *

Please rate the level of relationship you are seeking, 1 being Academic/Professional, 10 being Personal/Social *

Have you ever served as a mentor outside of this program? *

If “Yes”, how would you describe your experience?

What do you hope to gain by participating in MAP? *

Please let us know anything that you believe would help us make the best match that has not been covered in this application. *

Password _{must be between
8 and 20 characters}

Password Confirm

Mentor Advocate Partnership Program
Participation Agreement

The Massachusetts Institute of Technology Office of Minority Education (OME) appreciates your willingness to participate in the Mentor Advocate Partnership Program (MAP). OME promotes respect and responsibility for protégés, mentors, IACME partners, staff and other stakeholders. As such, it is crucial that a safe and respectful environment is established for both protégés and mentors.

All MAP Program participants are expected to read, adhere to and sign below acknowledging their commitment to fulfilling program expectations. By participating in MAP, I commit to:

Program Expectations

Connecting with my Mentor/Protégé once every month, from September 2024 to May 2025. Being proactive with scheduling monthly interactions and also promptly responding to communication
Submitting monthly online check-in forms, from September 2024 to May 2025
Engaging Office of Minority Education MAP program staff as needed
Attending End of Year Celebration event (if available)
Submitting End of Year survey
Abstaining from conduct considered improper and inappropriate. The prohibited conduct that is listed below is not an exhaustive list, as we cannot, with foresight, determine inappropriate conduct under every circumstance. Moreover, we do not limit the right to discharge participants for conduct that is not listed below.
- Knowingly disseminate or transmit content that is unlawful, harmful, threatening, abusive, harassing, tortuous, libelous, pornographic or invasive of another’s privacy
- Knowingly disseminate or transmit content that infringes on any patent, trademark, trade secret, copyright or other proprietary rights of any other party
- Knowingly disseminate or transmit any unauthorized advertising, promotional materials and goods, chain letters, spam, junk mail, or any other type of mass unsolicited email to others who have not agreed to receive such materials
- Impersonate another person or entity
- Stalk or harass another protégé or mentor
- Knowingly disseminate, transmit or make otherwise available any materials that contain software viruses, computer code, files or programs designed to interrupt, destroy or limit the functionality of any computer software or hardware
- Collect or store personal data about other protégés or mentors
- Knowingly disseminate or transmit illegal and illegally-obtained materials
- Fraternize outside of the professional mentor and protégé relationship
- Share confidential information

I agree to the code of conduct and to fulfill the MAP program expectations listed above for the 2024-2025 session

MAP - 2024-2025 SESSION

Mentor Application

CONTACT

INFORMATION

Hobbies and Interests

ICE BREAKER

MENTORING AGREEMENT

Mentor Advocate Partnership Program
Participation Agreement

MAP - 2024-2025 SESSION

Mentor Application

CONTACT

INFORMATION

Hobbies and Interests

ICE BREAKER

MENTORING AGREEMENT

Mentor Advocate Partnership ProgramParticipation Agreement

Mentor Advocate Partnership Program
Participation Agreement