* 1. Name

* 2. What is your Major?

* 3. Number of college credits completed prior to this semester:

* 4. Are you certified into your engineering major?

* 5. What is your cumulative GPA?

* 6. When do expect to get your engineering degree?

* 7. What are your career goals?

8. Have you been a mentor/mentee before?

* 9. Reference #1: Please provide the name, day time phone number and e-mail address of a supervisor (Current or Past, from a Voluntary or Paid Position that you have held within the past two years)

* 10. Reference #2: Please provide the name, day time phone number and e-mail address of a faculty member (include the name of the course/courses you completed with this faculty member, at what university and when)

* 11. I attest that all information provided in my application is true and accurate to the best of my knowledge.

Date:
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Thank you for submitting a mentor application to be considered for the Peer Mentor Program. If you have any questions, call 372-7615.

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