Complete and return this application to
Rachel Levine (rmlevine@engineering.uiowa.edu) in the Student
found on www.engineering.uiowa.edu/~econnect.
Name: ____________________________________________________________________________
Summer 2008 Address: _______________________________________________________________
City:
Summer Phone #:
______________________ email: _______________________________________
Fall 2008 Address:
__________________________________________________________________
City:
Fall Phone #:
____________________ email (if differs): ____________________________________
High School Graduated From
__________________________________________________________
Current Major: _______________________________
Minor/EFA: ____________________________
Class Standing as of Fall
2008 (circle): Soph Junior Senior Grad. Date___________________
Why do you wish to be an
Engineering Connection Mentor? __________________________________ ___________________________________________________________________________________
Please list campus/community
groups and hobbies you are involved in: ________________________
___________________________________________________________________________________
List suggestions for monthly
events that you would be interested in attending/ helping organize:______
____________________________________________________________________________________
I understand that by participating in this program I am entrusted to be a positive representative of the
about students with other students. I agree to attend a training session and complete all job duties
associated with the Engineering Connection program.
Signature:
________________________________________________ Date: ____________________