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Mentee Application Form
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* Indicates required question
Name
*
First and Last Name
Your answer
Home Address
*
Address, City, State, Zip Code
Your answer
Email
*
Your answer
Phone number
*
Your answer
Will you be available to participate in online sessions on the below dates: July 18th, July 25th, August 1st, August 8th, and August 15th. (sessions will run late morning)
Yes
No
Other:
Clear selection
If you answered "No" to the previous question, please explain?
*
Your answer
University or High School
*
Your answer
Major/Specialization
Your answer
What is the best way to contact you, initially?
*
Email
Cell Phone
Text
Summer Class Schedule (if applicable)
Course Name, Days, Time
Your answer
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