Full Name  *
College (Arts and Sciences, Communication, Engineering, etc.)  *
Major  *
Grad Year  *
If interested in graduate or professional school, please specify:

Please provide the name of your academic advisor  *
Home City  *
Home State  *
Mobile Phone  *
Marquette Email Address  *
Local Address Line 1  *
Local Address Line 2
Local City  *
Local ZIP  *
Areas of Interest (choose all that apply)

Other Areas of Interest
What geographical location (city and state) would you like to work in after graduation? Please list your first and second choices.  *
Why would you like to be considered as a mentee in the Mentor Program? Two paragraphs maximum.  *
What are your top two goals for your participation in the mentoring program? Goal 1:  *
Goal 2:  *
If selected, are you able to attend the mentor program kickoff from 7:45 a.m. - 9:15 a.m. on Tuesday, Sept. 16?

By checking this box, I hereby authorize Marquette University to release my name, email address, telephone number and/or biography as provided by me to my assigned mentor, even if I have chosen to place a FERPA (Family Educational Rights and Privacy Act) block on my record in CheckMarq.  *

For more information, please contact Dan DeWeerdt at (414) 288-4740 or

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