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E4 – Emerging Adults Signup Form
Contact (541)-729-2045 with any questions!
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Name
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First
Last
Email
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Phone Number
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No “-” or “()”
Birthday
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(XX/XX/XXXX)
Gender
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Male
Female
Other
Prefer not to say
Race / Ethnicity
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African-American
Latino
Asian
White
Other (please specify down below)
with? Ethnicity you
Highest level of education
No formal education
Some high school
High school diploma or equivalent
Some college
Associate degree
Bachelor’s degree
Professional degree
Why are you interested in getting a mentor? Are there any particular things you'd like a mentor to help you with?
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What special interests, hobbies, or leisure activities do you enjoy when you're not in school or at work?
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Please share any additional information about yourself which can help to match you with a mentor.
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