Name(Required)
Class Level(Required)
Ethnicity
Which affinity mentoring groups do you identify with? (Select all that apply)
Do you live on campus?(Required)
Languages Spoken
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Preferred method of contact (Select all that apply)
What’s the #1 thing you would like to get out of your mentorship experience?
Areas where you hope your mentor to make an impact
If you had to describe yourself (Select all which apply)
I authorize the verification of the information provided on this form. I give consent for the release of my email information to be used by the Mentor for the duration of the program(Required)