Thanks for your interest in HEMI!

Thank you for your interest in supporting the Higher Education Mentoring Initiative! Tell us a little about yourself and we'll contact you soon to schedule a time to talk.

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* 1. First Name

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* 2. Last Name

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* 3. What is your date of birth? (MM/DD/YYYY)

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* 4. Gender

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* 5. Phone Number

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* 6. Email

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* 7. How might you be interested in supporting HEMI? (Select all that apply.)

Mentor

Host an HEMI Information Session

Serve on a committee

Donate tickets, items, or services

Donate to the HEMI Scholarship Fund

Volunteer or Sponsor an Event

Facilitate a workshop or Meet-Up

I just want to learn more about this program

Something else:

Thanks for your interest in HEMI!

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. What is your date of birth? (MM/DD/YYYY)

Question Title

* 4. Gender

Question Title

* 5. Phone Number

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* 6. Email

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* 7. How might you be interested in supporting HEMI? (Select all that apply.)

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* 8. How did you first learn about HEMI?