Tusculum University-Greeneville-SSS-Mentee Application

SSS Pioneering Connections Mentee Application

Name*

First NameLast Name

Campus PO Box

Phone #

(999)999-9999

Choose one:

I live on campus.I commute from home.

If you live on campus, what dorm do you live in?

Gender

MaleFemaleI do not wish to report

Date of Birth

mm-dd-yyyy

Hometown

TU Email*

example@students.tusculum.edu

Major(s)

Minor(s)

Anticipated number of credits for fall 2021 Semester

Why Tusculum University?

What do you hope to gain by participating in the SSS Pioneering Connections Program?

What do you feel will be the most difficult aspect in your adjustment to college life?

Name your personal interests: (favorite sport(s), hobbies, recreation, or other activities)

What do you look for in a mentor?

Please list your personal and academic goals?

I agree if accepted as a Mentee, I will follow the rules and regulations of The SSS Pioneering Connections Program. I will also adhere to all college policies, which if violated, could affect my status as a mentee in the program.

Sign name

Date

mm-dd-yyyy