STAT - Student Participation Survey

STAT Alumni Mentor Program - Student Participation Survey

Junior, Senior and Graduate-level STAT memberships are eligible to receive an alumni mentor through the STAT Alumni Mentor Program. To participate in the program, fill out and submit this form:

Printable Participation Survey
1. Your Information
Last Name
First Name
Banner ID #
Title Select	Mr. Mrs. Ms. Miss. Dr.
Current Grade Level
Expected Graduation Date
Major(s)
Career Interest/Goal
E-mail
Current Mailing Address
City
State
Zip Code
Permanent Mailing Address
City
State
Zip Code
Phone Number
Do you authorize the Alumni Association to release your address and phone number to your mentor so that he or she can contact you?
Yes No
Would you prefer a female or male mentor, or do you have a preference?
Female Male No Preference
Where did you attend high school?
Do you participate in any clubs, activities or sports at SIUE? If so, which ones?

What do you wish you accomplish by participating in the STAT Alumni Mentor Program?

What are you looking for in a mentor?

Do you have any special interests that you would like to share with your mentor?

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

STAT: Students Today, Alumni Tomorrow

STAT Alumni Mentor Program - Student Participation Survey

Printable Participation Survey

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