Name
*
First Name
Last Name
Email:
*
Please use your @steu.edu address.
Phone:
*
Address
*
Street Address
Street Address Line 2
City
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
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District of Columbia
Florida
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Hawaii
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Maine
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Ohio
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Pennsylvania
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Tennessee
Texas
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Vermont
Virginia
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Wisconsin
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State
Zip Code
Campus Affiliation
*
E.g.: Men's Baseball, Business Club, CAB, etc.
Major/Field of Interest
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Expected Graduation Date
*
Are you available for one academic year (two semesters) to be in contact with your mentor once or twice a month? This could be via phone, text, email, Facetime, Skype, or in person.
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Yes
No
Have you participated in a mentoring program before?
*
Yes
No
Why are you interested in seeking a mentor? What would you like to learn from your mentor?
*
Additional Comments
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