Student Communication Report-Feb 2017
RequiredRequired Question(s)
Required 1.
Please provide the following information.

First Name:
Last Name:
Home Phone:
Email Address:

Required 2.
Please provide your cell phone number.

50 characters left.
Required 3.
What college or university are you attending?

50 characters left.
Required 4.
What is your current college major?

50 characters left.
Required 5.
Enter the full name of your mentor.

50 characters left.
Required 6.

Select the answer which best describes the contact you had with your mentor last month.

Met with mentor in person
Communicated with mentor by telephone
Exchanged e-mail with mentor
Sent e-mail to mentor, but did not receive response
Called mentor and left voicemail, but did not receive a call back
Received a call from mentor, but did not return the call
Received e-mail from mentor, but did not respond
Communicated with mentor by text message
Communicated with mentor by facebook
  • Comment:

  • 500 characters left.
Required 7.

What is something new that you learned from your mentor this month?


350 characters left.
Required 8.

What is some real life good news that you can share with us this month? ( e.g., internship/job placement, student organization, coursework/projects, study abroad/service-learning, and/or athletics)


1000 characters left.
Please provide your Social Media contact. (optional)
(e.g. Facebook Name, LinkedIn E-mail address/name, Twitter @, Instagram username)

350 characters left.