Mentor Program Student Application

Name*

First Name

Last Name

I am*

Male Female

Student ID*

Manhattan College Email*

You will only be contacted at this email address

School*

Major

Minor

GPA*

Expected Graduation Date*

Year*

Are you a transfer student?*

Yes No

Are you a veteran?*

Yes No

Are you a U.S. citizen?*

Yes No

Cell Phone Number*

Permanent Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone Number*

Do you live on campus or commute?*

On campus Off campus Commuter

On-Campus (Residence Hall), Off-Campus (apt or other residence not owned by school), Commuter (commute from permanent address)

Transportation*

I have the use of a car. I will use public transportation

High School*

High School City and State*

Briefly identify your intended career, your area of interest and why you want to participate in this program. Please be as specific as possible, and if applicable, indicate if you are pre-law or pre-health.*

Have you participated in the Mentor Program before?*

Yes No

Upload your photo*

No File Chosen

File uploads may not work on some mobile devices.

Electronic Signature*

[clear]

Use your mouse or finger to draw your signature above. 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.