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* 1. Name:

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* 2. At what email address would you like to be contacted?

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* 3. School

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* 4. What is your major?

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* 5. What is your GPA?

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* 6. This program is open to graduate and undergraduate students at the University of TN, Knoxville and Pellissippi State Community College. Please tell us if you are a graduate or undergraduate.

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* 7. List 3 words that would best describe you.

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* 8. Why would you like to be considered for the 2014-15 Student Mentoring Class? (100 Word Max)

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* 9. Please provide a brief description of your background, education, any internships and extracurricular activities, and special interests.

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* 10. Please indicate your availability by day to participate in WICT events:

  Early Morning (8:00am - 10:00am) Mid Day (11:00am - 1:00pm) Late Afternoon (5:00pm - 7:00pm) Evening (7:00pm - 9:00pm)
Monday
Tuesday
Wednesday
Thursday
Friday

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* 11. Briefly describe your career aspirations.

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* 12. Please list any personal development areas you would like to focus on. (2)

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* 13. Are there any schedule or transportation concerns that would prevent you from keeping your committment to the program? If so, please explain.

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* 14. What are your expectations for the mentoring program?

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* 15. What topics would you like your mentor to focus on?

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