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Student Application for University Minority Mentor Program 2008-2009

UFID (no dash):

First Name:

Last Name:

Birthdate:

Ethnicity:

Cell phone:

Other phone:

Gatorlink Email:

Other Email:

Parent or Guardian First name: Last name:

Permanent Address:

Address:

City: State:

Zip:


Local Address:

Address:

City: State:

Zip:

Summer Address (If different from above):

Address:

City: State:

Zip:

My first semester at UF will be: Summer B Fall

Session you would like to apply for:

Intended Major:

Other academic areas of interest:

List 3 goals you currently have for your first year at UF (can be academic, personal, social, etc.)
1.
2.
3.

Three things you like to do in your spare time
1.
2.
3.

Three things that are important to you
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2.
3.

Why do you want to take part in the University Minority Mentor Program:
( You may enter up to 1000 characters. )

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Please describe a person in your life who has served as a mentor or role model to you. In what way has this person contributed to your current success or helped you become the person you are today:
( You may enter up to 1000 characters. )

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Describe the relationship you would like to have with your mentor: (150 word limit)
( You may enter up to 1000 characters. )
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By submitting this form the mentee agrees to the following statement:

"I understand that in signing up to participate in UMMP, I am making a serious commitment to open and regular commication with my mentor. If for any reason, I am unable to continue in this program, I will notify the Dean of Students Office in a timely manner so that my mentor can be reassigned."

Please Note: In order to participate in UMMP, you should plan to attend the opening event on Friday, August 29, 2008, from 11:00-12:30 pm. If you know that you have class at that time, please forward a copy of your class schedule to ummp@dso.ufl.edu and alternative arrangements will be made for you to meet your mentor and be oriented to the program. Thank you!