H.G. Menke Mentoring Program

Mentor Application

Basic Information
* First Name
* Last Name
* Email address
* Confirm Email
Contact Information
Address 1
Address 2
City
State
Zip Code
Country
Phone
Mobile Phone
Work phone
Work phone ext.
Demographic Information
Gender
Education
Undergraduate School Name
Major
* Degree(s)
Degree Title(s)
Graduate School(s) Attended
Graduate Degree(s)
Graduate Degree Title(s)
Profession and Employment Information
* Profession
Other Profession(s)
Please list professional certifications
Present Employer
Position Title
Interests and Hobbies
Please list involvement with outside organizations
Program Questions
* Chi
* First year attended at the University of Illinois
* Last Year attended at the University of Illinois
* City and state of present employer
Last two employers
Favorite Lambda Chi Alpha memory
Lambda Chi Alpha officer positions held
City and state of previous two employers

* - Required field