Full Name |
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Local address |
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City |
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State |
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Zip |
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Home Phone |
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Preferred e-mail address |
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Employer |
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Current job title |
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Work Phone |
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Describe duties and responsibilities |
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SCSU undergraduate degree year |
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Major 1 |
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Major 2 |
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Minor 1 |
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Minor 2 |
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SCSU graduate/masters degree year |
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Major |
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Specialization |
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Additional education (additional SCSU degrees or degrees earned
at other colleges) |
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Career history |
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Career fields and majors you would be interested in mentoring:
(Choose up to 3) |
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Have you been an SCSU mentor in the past?
no
yes |
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What are you expecting to gain by participating in this program? |
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What skills and experiences do feel you have to offer a current
student? |
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Besides mentoring, would you or your company be interested
in participating in other campus activities? |
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Career fairs
Networking opportunities
Guest speaking
Mock interviews
Other (please specify)
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Additional Information/Comments: |
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