Upper Class Level II Mentee Form (2013-2014)

Upper Class Level II Mentee Form (2013-2014)

Please complete this form if you are an upper class student who would like to be paired with a faculty or staff mentor.

Name * First Last
UCA Banner ID *
Classification
(sophomore, junior or senior) *
Major (or anticipated major) *
Local Conway Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Cell or Home Phone Number * - (###) - ### ####
Email
(yahoo, gmail, hotmail, etc. NO cub unless you check it) *
List interests and organizational memberships

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