Incoming Freshman       Transfer Student  

Date of Application (mm/dd/yy) ID# (Last 4 digits) 

*First Name    Middle Initial  

*Last Name   Prefer to be called              

*Home Address

City   State  Zip   

*Home Phone (   )     Fall address is the same

Fall Address

City   State  Zip   

Fall Phone (   )     Don't know your Fall address

*Cell Phone (   )               Gender: Male    Female 

*UTA E-mail

Best way to contact you:        Email        Cell Phone        Home Phone

IF ANY OF THE ABOVE INFORMATION CHANGES PLEASE INFORM US IMMEDIATELY

Major :     Undecided CAP Student

If Undecided what major are you considering?      

Are you in the Honors College?

Ethnic Background (for statistical purposes only):

Which of the following areas are you looking to find out more about or receive assistance through the UTA-HOSTS! Program?

University Information       Student Organizations        Academic Resources

Reassurance/Support        Career Assistance               Campus Activities/Events

Arlington/Metroplex            Greek Life

 

Please note those activities you enjoy during your leisure time:

Favorite Sport:

Favorite Music:

Favorite TV Show:

Favorite Movie:

Please list at least three (3) of your favorite things to do during your leisure time not covered in the previous question.  For example, do you enjoy surfing the internet, gardening, racing, shopping, spending time with friends or family, etc.?

1. 

2. 

3. 

 

If you have any other preferences for your mentee, please list them here:

 

The answers to these last two questions and your phone numbers & e-mail (if provided) will be provided to your match (mentor) unless otherwise indicated on this form.

I understand that I am committing to be a mentee in the UTA-HOSTS! Peer Mentoring Program

  • My commitment if for Fall 2008 and Spring 2009.

  • I will contact my mentor if I have any questions or concerns, even if they haven't yet contacted me.

  • I will contact the Office of Student Governance & Organizations when my contact information changes.

  • I will contact the Office of Student Governance & Organizations if I cannot reach my mentor or have other problems.

Your Signature Date

You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you. You may review and have UT Arlington correct this information according to procedures set forth in UTS 139. The law is found in sections 552.021, 552.023 and 559.004 of the Texas Government Code.