REACH - University of Louisville

Ambassador Mentor Application

REACH Ambassador Mentor Application

Please fill out the information below. If you have any questions, contact Leighann Valdez.

Student Information
Name:
Student ID #: (7 digits)
Primary Email:
UofL Email (if different):
Local Address:
Local Phone:
Cell Phone/Other:
Permanent/Summer Address:
Permanent/Summer Phone:
Academic Information
Year/Classification:
(as of upcoming Fall Semester)
Major:
Cumulative GPA:
Education Information
High School:
Location:
Cumulative GPA: (minimum 2.5 GPA required)
Other Universities Attended:
Employment/Experience
Are you presently working in
another department at UofL?
Yes   No
Department:
How many hours per week?
Are you receiving financial aid? Yes   No
Are you receiving any scholarships? Yes   No
What aid or scholarships are you receiving?
Academic References
Name:
Address:
Relation:
Phone:
E-mail:

Name:
Address:
Relation:
Phone:
E-mail:
Other
Campus Activities:

Honors and Awards:
Citizenship
I attest under penalty of law that I am:
A citizen of the United States of America
An alien lawfully admitted for permanent residence
An alien authorized to work in the United States of America
Group Interview
Please indicate your first and second preference of time for the group interview (select two ONLY):
February 22nd, 9:00 - 11:00 a.m. 1st Choice 2nd Choice
February 22nd, 1:00 - 3:00 p.m. 1st Choice 2nd Choice
February 25th, 9:00 - 11:00 a.m. 1st Choice 2nd Choice
February 25th, 1:00 - 3:00 p.m. 1st Choice 2nd Choice





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