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Student Form Please note, all fields are required.
   

Please fill out the following with your information:

Name:
Student #
Gender: Female
Male
Year:     
Faculty:

Major:   

Your contact information:
Phone  
Email  
   
I prefer a mentor who is (check one):

Female
Male
No preference

 

Describe the field of interest to you (e.g. nursing, finance, pharmaceutical industry, etc):

What do you hope to achieve from the Mentoring program?


Please list some of your other interests (this will help us match you)


Questions? Contact Sean at kramers@fiu.edu or call 305-348-2238