Student Enrollment Form - Mentor Program

You will only be contacted at this email address.
Indicate your class year for the upcoming fall semester.
On-Campus (Residence Hall), Off-Campus (apt or other residence not owned by school), Commuter (commute from permanent address)
Please enter your Street Address, Apt #, City, State and Zip Code
This signature affirms that if I am accepted into the program, in addition to the ordinary mentor/mentee contact requirements, I agree to attend the meet and greet reception in the fall, the mentee workshop prior to meeting the mentor and the mentor dinner in February.