OSU - OMA

Required fields are indicted with an asterisk (*)

Personal Information & Permanent Home Address
First Name: *
Last Name: *
OSU Email: *(e.g., coleman.236@osu.edu)
Ethnicity: *
If you selected "Other" for Ethnicity please type in your Ethnicity here
Gender *
Permanent Address: *
Permanent City: *
Permanent State: *
Permanent Zip: *
Mobile Phone (or permanent house phone): *
University Information (please complete if different from above information)
Class Rank for the Coming School Year: *
Campus Dorm:
Dorm Room:
Local Address:
Local City:
Local State:
Local Zip:
Local Home/Dorm Phone:
Mentoring Information
Did you have a mentor last academic year? *
If so, Mentor's Name:
Would you like to continue your past mentoring relationship? *
Intended Major: *
Intended Major Other:
Career Goal: *
Hobbies 1: *
Hobbies 2: *
Hobbies Other:
As a participant of the Mentoring Program: I will attend a mandatory orientation session. I will follow all the guidelines and requirements of the Mentoring Program. I grant the Mentoring Program permission to begin the process of assigning mentor(s) for the upcoming academic year. By checking the box below you expressly agree to the above stated conditions in applying as a mentee with the Mentoring Program. I agree to the above stated conditions.