| Last Name: First Name: |
FOR CURRENT STUDENT: |
| Box Number: E-mail: |
| What is your intended major: |
| College GPA: |
| Campus Extension: |
| Ethnic Group: |
| African American |
| Asian |
| Hispanic |
| Native American |
| Other , Please State: |
| Please check any of the following: |
| Yes! I would like to have a mentor for the year 2003-2004! |
| Yes! I am curious, mail me more information about the Mentoring Program. |
IF YOU WOULD LIKE TO BE ASSIGNED A MENTOR, PLEASE FILL THE FOLLOWING: |
| Current activities at Wheeling Jesuit University: |
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| Some of my interests and hobbies are: |
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| I want to join this Mentoring Program because: |
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| My future career goals are: |
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| What expectations do you have for your mentor? |
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| What expectations do you have for yourself and your experiences in the program? |
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| Suggestions or Comments: |
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Thank you for taking the time to complete this application. We will be pairing you up with your mentor and we will contact you as soon as that is accomplished. If you have any questions, please contact us directly at 304-243-2285. Please answer the questions to the best of your ability. Once again, thank you for being a part of the Multicultural Mentoring Program! |
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