Application

MENTORSHIp program application

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Role *

Mentor Mentee

Oxy Class Of *

Major *

Occupation / Employer *

What do you hope to gain from this experience? *

Can we tag you in future photos on social media? *

Yes No

If yes, please share your social media handles *

By submitting this form, I acknowledge that I have read the program description and can commit to participating in this program from September - May. *

I agree

Submit