Great, you're ready to take the next step. Just fill out and submit the application form below. Be sure to include either an email address or phone number so that a representative of the program will know how to contact you. Good luck! 

Mentor Program Student Application Form:
 

First Name
Last Name
Address
(continued)
City
State		- - AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip Code
Email Address		Home   Work
Home Phone
Work/Mobile Phone		Work   Mobile

Best time to call?		(select) Weekdays Weekends   (select) Morning Afternoon Evening
How did you hear about this program?		(select) Brochure Counselor Teacher Librarian Campus Newspaper Student Orientation Friend Website Other
What is your favorite academic subject or specialty?
What is your major?  (or what do you think it will be?)
What are some of your interests and hobbies (like sports, literature, computers, movies, music, academic subjects, etc.)?
You can arrange to meet with your Mentor almost any time from breakfast to dinner, whatever works for both of you. What time of day would be best for you?
Please write a short paragraph, if you would like, introducing yourself to your new mentor.
Anything else you'd like to add? Special issues, ideas or needs?