Contact Information

Title:	Choose One Dr. Mr. Miss Ms. Mrs.
First Name:
Last Name:
Job Title:
Department:
College/Division:	Select One Athletics College of Agriculture and Life Sciences College of Architecture College of Education and Human Development College of Geosciences College of Liberal Arts College of Medicine College of Science College of Veterinary Medicine Division of Administration Division of Academic Affairs Division of Finance Division of Student Affairs Dwight Look College of Engineering Evans Library General Academic Programs George Bush School of Government and Public Service Mays Business School OTHER: Designate in comments field below
Mail Stop:
Office Location:	(building & room)
Email Address:
Work Phone:
NetID:
Comments, Clarifications:

1.	Do you wish to renew your membership to be an ATMentor for the upcoming year?	Yes  No
2.	Would you be interested in serving as a representative for the Mentors in your College/Department for the upcoming year?	Yes  No
3.	Do you want to be on the ballot as a candidate for the ATMentors Executive Committee?	Yes  No
4.	Do you want to volunteer to staff the ATMentors resource table at New Student Conferences and other events throughout the year?  (Answering questions and distributing brochures about ATMentors)	Yes  No
5.	Do you want to volunteer to be matched with a student in the ATMentors Matching program?	Yes  No
6.	Do you want to volunteer to speak in public on behalf of the ATMentors program? (Mostly to Mother's clubs, which are frequently out of town.)	Yes  No
7.	Do you want to volunteer to be matched with a Regents Scholarship recipient?	Yes  No