Foster Scholars Mentee Application

* fields are required

First Name: *

Last Name: *

Student ID Number: *

Home Address: *

Apt #:

City: *

State: *

Zip: *

Phone (Primary): *

Phone (Secondary):

Email: *

Gender: *

Major(s)/Field(s) of Study: *

Which campus do you attend for most of your classes? (Select One): *

Indicate support services for which you need assistance. (Check all that apply): *

Tutoring
Counseling
Career Assessment/Planning

Indicate areas of development for which you want assistance (Check all that apply): *

Other Assistance: *

Indicate if you are currently a: *

Are you currently being mentored by a Tri-C faculty or staff member: *

Do you have any specific request for a mentor: *

If so, please list the name of the mentor you request and list any other requests:

MENTEE AGREEMENT

I agree to the following responsibilities and expectations:

I Agree: *

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