STAT - Mentor Participation Form

STAT Alumni Mentor Program - Mentor Participation Survey

To participate in the STAT Alumni Mentor Program, fill out and submit this form:

Printable Participation Survey
1. Your Information
Last Name
First Name
Maiden Name
Title Select title	Mr. Mrs. Ms. Miss. Dr.
SIUE Graduation Year
Degree
Major(s)
E-mail
Current Mailing Address
City
State
Zip Code
Company
Job Title
Work Mailing Address
City
State
Zip Code
Phone Number
Do you authorize the Alumni Association to release your address and phone number to your student so that he or she can contact you?
Yes No
Would you prefer a female or male student, or do you have a preference?
Female Male No Preference
What was your hometown and high school when you attended SIUE?
Did you participate in any clubs, activities or sports while at SIUE? If so, which ones?

Where do you work now? Please describe your day-to-day responsibilities.

Do you have any special interests or hobbies that you would like to share with your student?

Do you have any children or other relatives who attended or are now attending SIUE?

Would you like to provide any other information that would assist us in making a good match?

STAT: Students Today, Alumni Tomorrow