Get Involved > Mentor Application

Personal Information

First Name

Last Name

Age

Institution

Year

Race

Black/African-American
Latino(a)/Hispanic
Asian/Asian-American
White/Caucasian
Native American
Hawaiian/Pacific Islander

Gender

Male Female

Area of Academic Concentration

Contact Information

Address

City

State

Zip

E-mail

Phone

Availability

In the table below, please place check marks indicating the days and times you are available to mentor. (NOTE: Most programs meet on week days between 2PM and 8PM. Allow one hour travel time.)

Mon

Tue

Wed

Thr

Fri

Sat

9am-10am

10am-11am

11am-12pm

12pm-1pm

1pm-2pm

2pm-3pm

3pm-4pm

4pm-5pm