UH International Student Services • University of Hawai‘i at Mānoa
2600 Campus Road QCLSS 206, Honolulu, HI, 96822 • Phone:(808)956-8613 • http://www.hawaii.edu/issmanoa


Please complete this form if you a new international student and want to request a Mentor. You will be assigned to a Mentor or to a small group of Mentors and Mentees. Click SUBMIT at the bottom after completing the form.

All date fields in format mm/dd/yyyy
* required field

* First Name: * Last Name:
* Gender: Female  Male * Date of Birth: (mm/dd/yyyy)
UH ID: * Major:
* Education Level: Graduate  Undergraduate  Exchange
* Home Country:
Languages Spoken:
Email: @hawaii.edu (Do not enter @hawaii.edu) * Alternate Email:
Phone (in Hawai'i): Arrival Date in Hawai'i:
Hobbies, Interests:
Anything you want the coordinator to know:

* * *


  1. I agree to commit as a Mentee from the day I am assigned a Mentor to the end of the program.
  2. I agree that ISS can provide the following information about me to other Mentors and Mentees: Name, Gender, Student Classification, Major, Home Country, and E-mail Contact (UH E-mail & Alternative).
  3. I agree that any information shared by the Mentors and mentees is considered confidential, I will not share this information without express permission.
  4. I agree to respect the UH Manoa Student Conduct Code.
  5. I agree not to enter into a consensual, romantic relationship with the Mentors and Mentees while participating in the Mentor Mentee Program, therefore, I agree there will be no physical contact of a romantic nature with participants.
  6. I understand that at any time during my participation in the program I can contact the Mentor Mentee Program coordinator, assistant or advisor with any concerns, problems, and issues.
  7. I agree that I, my Mentors or Co-Mentees may terminate the relationship at any time. If the relationship is terminated, I agree to immediately inform the Mentor Mentee Program coordinator, assistant or advisor.
  8. I agree that at any time I need to remove myself from the program, I will inform the Mentor Mentee Program coordinator, assistant or advisor as soon as possible and that I can request that the Mentor Mentee Program inform my Mentor and Co-Mentees.
  9. I agree that the Mentor Mentee Program may terminate a Mentor Mentee relationship at any time.
  10. I understand that all Mentors participating in the program will be required to agree to a similar agreement.

* I have read and understood this Mentee Agreement of the Mentor Mentee Program.