* - Denotes REQUIRED Information. Please be sure that you include an email address that you check frequently and use your current home and cell phone numbers.
*Age At Time Of Arrival:
*Email Address :
*Home Phone #:
*Cell Phone #:
*What issues do you anticipate needing assistance with?
Please list any high school organizations or extracurricular activities in which you participated.
What are your Hobbies/Interests?
Date of Freshman Orientation (mmddyyyy):
*I prefer a student mentor of my gender: