Prairie View A&M University
Career and Outreach Services
Corporate Mentor Application
__ Yes, I would like to become a Corporate Mentor (Complete A&B)
__ No Thanks! I wish you the best with the program (Complete A)
Part A
Name: ____________________________________ Company:__________________________________
Address: ____________________________________________________________________________
City:________________________
State: ________________ Zip Code: ___________________
Telephone No.:_________________________________ Email:_________________________________
Part B
University:_____________________________ Major_______________ Degree:__________ Year:____
University:_____________________________ Major_______________ Degree:__________ Year:____
Company Position/Title: ___________________________________ Area_________________________
Organizational Affiliation (s)_____________________________________________________________
_____________________________________________________________________________________
I am interested in working with: □ Male □ Female □ Freshman □ Sophomore □ Junior □ Senior
The student should be studying____________________________________________________________
I have identified _______________________________________ and will serve as the mentor!
Mentee may contact me at Phone:________________________ Day(s)____________Time(s)_________
-------------------------------------------------Office Use---------------------------------------------------(Mentee Assigned:) _____________________________________________________________
Mailing Address: _______________________________________________________________
City:________________________ State: ____________ Zip Code: _____________________
Telephone No.: Day:________________________ Evening:___________________________
E-Mail Address(1) : _____________________ E-Mail Address(2) : _____________________