Mentor Registration

First Name:

Last Name:

Year of Graduation:

Degree:
Electrical Engineering
Computer Science
Computer Engineering
Other (specify below)
(Other Degree):

City:

State/Province:

ZIP/Postal Code:

Country:

Phone:

E-mail Address:

Employer:

Title/Position:

Did you attend a commonwealth (branch) campus?

Yes

No

If so, which campus?

Do you require your mentee to be authorized to work in the U.S.?

Yes

No

What is your preferred method of communication (please select at least one)?

Expertise (upto 500 characters):

Choose the technical area(s) in which you feel comfortable mentoring (maximum 3):

Choose the career field(s) in which you feel comfortable mentoring (maximum 3):

Choose the industry(ies) in which you work/have worked (maximum 3):

Department of