OSU - OMA

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)
Autumn 2008 Class Rank: *
Campus Dorm:
Dorm Room:
Local Address:
Local City:
Local State:
Local Zip:
Local Phone:
Mentoring Information
Did you have a mentee last academic year? *
If so, Mentee's Name:
Would you like to continue your past mentoring relationship? *
Intended Major: *
Intended Major 2: *
Intended Major Other:
Career Goal: *
Hobbies 1: *
Hobbies 2: *
Hobbies Other:
Submitting this application grants the Office of Academic Advancement permission to monitor my academic process. This information will be used to identify students who need academic assistance and will be kept confidential. By submitting this application I agree to a one year commitment and a minimum of five hours per quarter with the Mentoring Program. I grant the Office of Academic Advancement permission to monitor my academic process.