*  required fields

* Name:   

Mailing Address:    

* Street:  

* City:   

* State: *  Zip:

* Home phone:  

* Cell phone:

* E-mail:  

* Major:

* Date of Birth

* Race/Ethnicity:

*Please check those that apply:
FRESHMAN TRANSFER   FEMALE MALE

*My Hobbies include:

*Is there any specific information about yourself that would help us
in matching you with a mentor?

* Please rank your preferences for mentor pairing:

Male     Female   Same Hometown    

  Same Major    Same Hobbies  Same Interests  

Anyone

* Are there specific characteristics in a mentor that you would want us to consider?

*What do you want to receive from your mentor?  Check all that apply:

Tutoring/Academic Support     Time Management     

Campus Resource                  Social Support     

Other (Special Skill)  

* My expectation of the mentee experience is:

* My expectation of the mentor is:

* T-Shirt Size:   S      M     L      XL   2XL   

 *  Date