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Step Up, Reach Back Intern Application

* First Name

* Last Name

* Cell Phone

* Email

* Address

* City

* State

* Zip

* Major

* Anticipated Graduation (MO/YR)

ASUMH GPA (if applicable)

Entering Freshman with no ASUMH GPA

High School GPA

* How did you hear about the Mentoring Program? Why have you decided to apply?

* What are the three biggest challenges you face right now?

* What are the three biggest challenges you think you will face when you graduate?

* How do you see the Mentoring Program helping you deal with these challenges?

* What do you hope to gain from your mentor experience? List two or three things you would like your mentor to provide.

* Provide a short biography. Share your interests, hobbies, or any other comments you wish to include.

I am a returning intern

An important part of the Leadership Intern program is service to others. Reaching back after you have been through the program and helping a new member of the program is encouraged. Consider the list of ideas below and mark at least two things you would be willing to do.

Promote the Leadership Intern program by manning a booth a special event

Assist with the Teen Girls Go To College Event

Be paired with a new intern/new student and serve as s “student mentor” during her freshman year

Help organize an community service activity

Speak to community and campus groups about the internship program

Add your own ideas or thoughts on how to reach back

Statement of Commitment

By signing this form, I agree to the following:

I will enroll in at least 6 credit hours per semester.
I will maintain at least a 2.0 cumulative GPA.
I will attend orientation, retreat, by-monthly meetings with my mentor(s), and any other required activities on the attached required activities list.
I will participate in planning and executing a leadership event.
I will provide feedback to the mentors.

I confirm that all information on my application is accurate and I give the Women’s Leadership Center permission to verify any information included in this application. My signature below represents an awareness of my commitment and responsibilities to my mentor(s) and the Leadership Intern program.

* Signature

* Date