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

What aid or scholarships are you receiving?
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

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