Protg Application

PLEASE PRINT or TYPE

Name:
Last First

SID#:

Address:
Street Address City, State, Zip

Cell Phone: Email Address: Alternate Email: Will you be working this semester? Emergency Contact: Name:

Home:

Date of Birth: Major: T-Shirt Size: If so, how many hours per week:

Phone #:

Please tell us about yourself so that we can better match you with a student mentor. Include any hobbies, special interests, activities that you were involved in during high school, and how you spend your leisure time. (Attach an additional sheet if necessary)

Are there specific characteristics you would want us to consider in matching you with a mentor? What do you expect to gain from this program? Do you have any special needs that need to be addressed? [ ] Special Diet (ex: vegetarian) please state [ ] Medical Needs or special accommodations [ ] Other Which of the following student services are you most interested in? Check as many areas as needed: [ ] Career Assessment/ Planning [ ] Writing Skills [ ] Study Skills [ ] Academic Advisement [ ] Note taking [ ] Time Management [ ] Stress Management [ ] Textbook Comprehension [ ] Financial Aid [ ] Other [ ] Use of Library [ ] Tutoring [ ] Test-Taking [ ] Learning Styles

Please return this application to: Jeanette Broshears Director of Student Life and Transition Services 1201 West University Drive, UC 305A Edinburg, Texas 78541