Office of Minority Affairs
Academic Advancement Services
Mentoring Program
Mentee - Program Application

Required fields are indicted with an asterisk (*)

Personal Information

First Name: *
Last Name: *
Email: *
Ethnicity: *
If you selected "Other" for Ethnicity
please type in your Ethnicity here
Gender *
Permanent Address: *
Permanent City: *
Permanent State: *
Permanent Zip: *

University Information
(please complete if different from above information)

College Status: *
Campus Dorm:
Dorm Room:
Local Address:
Local City:
Local State:
Local Zip:
Local Phone:
Intended Major: *
Intended Major Other:
Hobbies 1: *
Hobbies 2: *
Hobbies Other:

As a participant of the Mentoring Program:

I will attend a mandatory orientation session.

I will follow all the guidelines and requirements of the Mentoring Program.

I grant the Mentoring Program permission to begin the process of assigning mentor(s) for 2007-2008 academic year.

By checking the box below you expressly agree to the above stated conditions in applying as a mentee with the Mentoring Program.

I agree to the above stated conditions.