S-Plan Mentee Application

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S-Plan Mentee Application

Please complete the following application and submit it one of three ways:

Submit electronically via this Web site
Fax to (814) 865-7212
Mail or deliver to the Office of Health Promotion and Education at 237 Ritenour Building, University Park, PA 16802

This application is due August 28 , 2008. You will be contacted by a S-Plan mentor in the beginning of the semester.

General Information

Name:
Gender		Ethnic Background
City/State:
Local/PSU Address (if known) :		Local/PSU Phone (if known):
Primary E-mail:
PSU E-mail (if known):		Cell Phone:
Intended Major:

Please name two strong interests you have (for example, activities you were involved in during high school).

Any questions regarding your application may be directed to the S-Plan Advisor at (814) 863-0461.

Agreement

By submitting this form electronically, I agree that to the best of my knowledge all of the above information is correct. I will be paired with a S-Plan mentor for one year and will maintain ongoing communication with my mentor.

Penn State is an affirmative action, Equal Opportunity University. Membership in S-Plan will not be based on race, national origin, sexual orientation, gender, veteran status, or age.