e-PMP Mentor Application Form 2012-2013

 
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1. Name
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2. What is your Major?
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3. Number of college credits completed prior to this semester:
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4. Are you certified into your engineering major?
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5. What is your cumulative GPA?
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6. When do expect to get your engineering degree?
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7. What are your career goals?
8. Have you been a mentor/mentee before?
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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)
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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)
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11. I attest that all information provided in my application is true and accurate to the best of my knowledge.
MM DD YYYY
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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