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University of Oregon
Mentor Application 2016-17
Date of Birth:
Please self-identify Racial/Ethnic Identity:
Grade Level in Fall 2016 (please check one):
Family Educational Background: (have either parent or guardian completed any of the following)
Community College/Associate's Degree (2 year degree)
Bachelors (4 year degree)
Terminal Degree (Masters, PhD)
What is your Major(s)/Area(s) of Study?
Are you considering declaring or have you declared a Minor?
Expected Date of Graduation:
Do you identify with...? Please check all that apply:
First generation college student?
Pathway Oregon Scholar?
Undergraduate Support Program?
First language other than English? If so, which language(s)
Diversity Excellence Scholar?
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