��«��Ƶ-CU Leadership Program Application

Thank you for your interest in becoming a mentor for the ��«��Ƶ-CU Leadership Program.

Please contact Jessi Follett��with any questions.

Indicates required field

Name

Professional/Academic Suffix

Job Title & Company (Retired if applicable)

Phone

What is your LinkedIn public profile address, professional website, or business link ? (If not applicable, put N/A)

Tell us a little about your professional background and some interesting facts that you think prospective mentees may want to know about you. (please limit your response to 150 words as it will be used for your bio)

Please offer a few words of advice to students based on your leadership experiences. (please limit your response to 150 words)

Please upload a good quality headshot that we can use for your bio.

One file only.
5 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Are you willing and able to commit to a 14-hour requirement for this program?

��Yes

��No

Have you ever been convicted of a felony?

��Yes

��No

Referred by:

Please explain

Reference Email Address

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��«��Ƶ-CU Leadership Program Application