*Please note that this program is strictly for 2019 BSA participants.

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* 1. First Name:

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* 2. Last Name:

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* 3. Student ID Number:

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* 4. Email Address:
*Be sure to check this frequently

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* 5. Cell Phone Number:

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* 6. Gender:

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* 7. Major:

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* 8. Who was your Summer 2019 BSA Mentor?

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* 9. What is your availability during the Fall 2019 semester? Check all that apply.

  10:00-11:00am 11:00-12:00pm 12:00-1:00pm 1:00-2:00pm 2:00-3:00pm 3:00-4:00pm 4:00-5:00pm 5:00-6:00 pm 6:00-7:00 pm 7:00-8:00 pm
Monday
Tuesday
Wednesday
Thursday
Friday

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* 10. In what ways could you use some support during your freshman year?

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* 11. What are your hobbies or interests?

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* 12. What are your career goals?

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* 13. Why do you want to be paired with a Navigator?
*Scholars will be matched with a new big brother/sister.

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* 14. Emergency Contact's First and Last Name:

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* 15. Emergency Contact's Relationship:

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* 16. Emergency Contact's Phone Number:

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