Out of State Student Mentor Application 2007-2008

Part I: Student Information

Name:

Email:

Last for digits of SSN:

Local Address:

Home Phone #:

Cell Phone #:

Year:
Fr So Jr Sr

Date of Birth (MM/DD/YY):

Hometown:

Majors/Minors:

List Extracurricular Activities and Involvement:

Hobbies & Interests (Please Check ALL that apply):
Acting/Drama
Art/Design
Cultural Events
Dance
Political Events
Foreign Languages
Movies
Outdoor Activities
Indoor Sports
Outdoor Sports
Music
Photography
Trips/Tours
Reading/Writing
Games (Video, Board, etc.)

Part II: Short Answer

1. Why are you interested in serving as out of state student mentor?

2. What qualities, skills, and experiences do you have that will help you to be a successful mentor?

Part III: Next Steps
Make sure that you have…

□  A completed recommendation form from a USC faculty or staff member

□ Turn in your completed application and recommendation form by 5 pm on Friday December 1, 2006. After your application has been reviewed, you will be contacted for a brief interview. We look forward to meeting you and THANK YOU for your interest in the Out of State Student Mentor Program!