The following form is used for matching purposes only. It will not affect your chance of receiving a mentor. If there is any question that you do not feel comfortable answering, feel free to leave it blank.
Date Submitted
Tue Jan 06 04:05:29 2009
Session
First Name
Last Name
Email Address
Home Address
Apartment No
City
State
Zip Code
Home Phone
Work Phone
Status in LaGuardia (select one)
If you are a student, what is your major?
If you are a staff member, what department do you work for?
Do you speak any language(s) other than english?
If 'yes' please list
What are your hobbies/Interest?
How many students would you like to mentor?
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