Personal Information
Name:                      Permanent Address:
Local Address:                      FSU ID
E-Mail Address:                     Permanent phone:                     Program:
Local Phone:                     Male:        Female:
Personal Characteristics
Career Goals
Hobbies
Are there specific characteristics you would want us to consider in matching you with a mentor?
Is ther other information about yourself that would help us match you?
What do you expect to gain from this program?
Which of the following student services are you most interested in? Check as many as needed	Tutoring                                         Time Management        Academic Program Planning           Test-Taking        Career Assessment / Planning         Learning Style        Stress Management                        Study Skills
Program Information
Class Standing	Freshman        Sophomore        Transfer
Program / Major / Curriculum
Will you work this semester?         Yes        No            If yes, how many hours per week?