Clark University/Worcester Professional Application Program
Student Mentee Application

Student Information
First Name  Last Name  Sex
 
Year of Graduation  

Major  Minor  

GPA  Email

Phone     Alternate Phone    

Home Address
Street City/Town State  Zip

Campus Box #

Questions
Please make sure you answer all five questions

1. Why do you wish to apply for this program?


2. What are your career field interests?


3. What do you wish to gain from this program?


4. What are your interests, hobbies and/or special skills/talents?"


5. Do you have access to transportation? Yes No