General Information

Name:      ASU ID#:
Email Address:

Birthdate:      Current Phone:
Alternative Phone:

Gender: Male      Female

Summer Address

City: State: Zip:

Local Address for 08-09 School Year

City: State: Zip:

Application Questions

Will you be living on campus during the 08-09 year?   Yes      No

If yes, where?  

What is your expected course load (credit hours) for the 08-09 school year?
Fall 08:      Spring 09:

Exploratory Major Track:
Social & Behavioral Sciences      Humanities, Fine Arts & Design
Health & Life Sciences                Math, Engineering, Physical Sciences & Technology

Are you able to attend a monthly social program (early weekday evenings and sometimes weekends)
with your mentor during the 08-09 school year?   Yes      No

Why are you interested in being matched with a peer mentor during your first year at ASU? (short answer)

If you would like to request a specific mentor, please provide his/her:
Name:      ASU ID: