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P.O. Box 581254
Minneapolis, MN 55458-1254
(612)332-0406

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Senior Mentor Application Form

Name:
Address:
City:
State:     Zip:
Phone:
E-mail:
Company:
Co. Address:
City:
State:     Zip:
Phone:
Position:

 I would like to mentor one Page Scholar.

 I would like to mentor more than one Page Scholar.        Total:

I would like to E-mentor one Page Scholar.
 
  I would like to E-mentor more than one Page Scholar.    Total:
 
  1. Where is your hometown?  What high school did you attend and in what city was it located?


  2. What college or university did you attend?


  3. What was your field of study or major?


  4. Please list your interests or any activities in which you are involved, such as sports, community projects, hobbies, volunteer experiences:


  5. List any professional organizations to which you belong:


  6. Have you been a mentor before?     No     Yes

    If yes, briefly describe:


  7. What is your gender?     Male     Female

  8. What is your ethnic background?
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