Please note that a copy of this form will be given to your mentor. Please include any information about yourself that you think will help us match you with a mentor.

Name:

E-mail address:

Year you graduated from college:

Anticipated year you will graduate from the Journalism School:

Are you a full-time or part-time student?:
Full-time Part-time

Home address:

Home phone number:

If you are working, please provide the business name and phone number

Primary area of interest: (please check only one)
Newspapers Magazines Television Radio New Media Other (please specify):

Secondary area of interest: (please check only one)
Newspapers Magazines Television Radio New Media Other (please specify):

Short-term career goal (upon graduation):

Where (city/region/country) do you hope to work after graduation?:

Long-term career goal (more than five years after graduation):

Is there a subject/beat you are particularly interested in covering? (i.e. business, entertainment, religion, health, sports, metro):

What do you hope to gain from your relationship with a mentor?

If you would like to send your resume, please cut and paste it in the box below: