Student Participation Form for the Alumni Mentor Program

Your Major at NC State

Your Classification (first-year sutdent, sophomore, junior, or senior)

Expected Graduation Date

Permanent Home Address

Mailing Address

City

State

Zip

School Address

Mailing Address

City

State

Zip

Contact Information

Best Phone Number to Reach You

Best Email Address to Reach You

Apsirations

Your Career Interests(s)

Your Further Education Interest(s)

Provide any special requests you would like us to know