Name: *
800#: *
Age: *
Expected Graduation Year(s): *
Resident or Commuter: *
Major/Minor(s): *
Email: *
Address: *
City: *
State: *
Zip: *
Home Phone Number (999-999-9999): *
Other student organization involved in?
Personal Hobbies and/or interests:
What do you want to get out of the program?
Where do you want to be in 5-10 years?
What are you looking for in a mentor?
*By signing this form, I agree to all terms and conditions of the Student Alumni Mentoring program. I understand that this program requires two evenings a semester and regular communication. I commit to building a mutual relationship with my mentor, to hear about new dreams and challenges, to share my own stories, to respect the difference between us, and provide guidance to the best of my ability.
Signature: (initials) *