Mentorship Circle
Most Diverse Tech Hub

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* 1. First Name

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* 2. Last Name

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* 3. Contact Information

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

Email Address *

Phone Number *

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* 4. Which race/ethnicity best describes you? (Please choose only one.)

African American

Asian American

Asian/Indian Subcontinent

Hispanic/Latino

Mexican American/Chicano

Native American

Native Hawaiian/Pacific Islander

Puerto Rican

White/Caucasian

Multiple ethnicity / Other (please specify)

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* 5. Name of the 2 or 4 year college/university you are currently enrolled in

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* 6. Anticipated Graduation Year

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* 7. What is your major?

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* 8. Location of High School you graduated from

City/Town *

State/Province

Country *

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* 9. Hometown zipcode (enter 00000 if you are an international student)

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* 10. Describe your interest in a building a career in tech

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* 11. Have you had an internship or job in tech?

Yes

Mentorship Circle
Most Diverse Tech Hub

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Contact Information

Question Title

* 4. Which race/ethnicity best describes you? (Please choose only one.)

Question Title

* 5. Name of the 2 or 4 year college/university you are currently enrolled in

Question Title

* 6. Anticipated Graduation Year

Question Title

* 7. What is your major?

Question Title

* 8. Location of High School you graduated from

Question Title

* 9. Hometown zipcode (enter 00000 if you are an international student)

Question Title

* 10. Describe your interest in a building a career in tech

Question Title

* 11. Have you had an internship or job in tech?

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* 12. If yes, where?

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* 13. Are you currently involved in any clubs or organizations focused on tech? Please describe.

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* 14. What do you hope to gain from participation in this mentorship program?

Mentorship CircleMost Diverse Tech Hub

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Contact Information

Question Title

* 4. Which race/ethnicity best describes you? (Please choose only one.)

Question Title

* 5. Name of the 2 or 4 year college/university you are currently enrolled in

Question Title

* 6. Anticipated Graduation Year

Question Title

* 7. What is your major?

Question Title

* 8. Location of High School you graduated from

Question Title

* 9. Hometown zipcode (enter 00000 if you are an international student)

Question Title

* 10. Describe your interest in a building a career in tech

Question Title

* 11. Have you had an internship or job in tech?

Question Title

* 12. If yes, where?

Question Title

* 13. Are you currently involved in any clubs or organizations focused on tech? Please describe.

Question Title

* 14. What do you hope to gain from participation in this mentorship program?

Mentorship Circle
Most Diverse Tech Hub