1.	Name*

2.	Degree & Major*

3.	Home Address*
	Street   City   State   ZIP

4.	Home or Cell Phone*

5.	Email Address*

6.	I am interested in serving as a Career Mentor to help current students as they explore career options.
	-- None --Yes No

7.	Please choose the response that best describes your current employment situation:*
	I am employed (skip section A) I am employed but seeking a new position (skip section A) I am employed and furthering my education (complete sections A and B) I am furthering my education (complete only section A) I am not currently employed but seeking employment I am choosing not to be in the workforce (please explain reason) Other, please specify