*  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

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

 * Date: