Minority Mentor Program Application

The Office Of Minority Student Programs (MSP) is designed to enhance the quality of the educational experience for students from underrepresented populations through programs, services, advocacy and referral to appropriate resources.

* Indicates the field is required and must be completed

GENERAL INFORMATION

First Name *
Last Name *
Address
City
State
Zip
Phone (e.g. 572-555-1234)
E-mail (e.g. jdoe@hotmail.com)
Status *
1st Year Student Returning Student
Ethnicity *
African American Asian American Native American
Hispanic Other  
Please Select The Program That You Are Applying For: *
Minority Mentor Program more info
Peer Mentor Program more info
Student Support Services  
Matching Success Award Program more info
INROADS  
HAMP more info

HIGH SCHOOL INFORMATION

Grade Point Average * on scale
ACT Composite *
SAT Composite *
High School
High School Address
High School Phone (e.g. 572-555-1234)
Counselor/Principal
Class Rank out of (# of students in graduating class)

PERSONAL INFORMATION

Intended/Current Career Major At Southeast
Why Have You Chosen This Particular Major And/Or Career
High School/College Activities
Honor Awards Or Special Recognition
Work Experience
Why Are You Interested in Participating In the Mentoring Program?
Who Is The Person (Living Or Deceased) You Most Admire, And Why?
What Is The Best Book You Have Read Recently? Why?
Do You Know Any Current Southeast Students? Yes   No
If Yes Please Give Name(s) Of Known Student(s)(Optional)
Additional Information
Anything else you think might help us match you with appropriate on-campus mentors
Additional Comments