TRIUMPH Header

APPLICATION FOR GENERAL MEMBERSHIP

 

 * = Required Field
 * Semester:  
                                                        

 * Year:  
     
 
 * First Name:      * Last Name:    M.I.:  
 
 * Date of
   Birth:
   mm/dd/yyyy  * Racial
   Identity
   
 
 * Phone
   Number: 
  999-999-9999  * Email
   Address: 
   
 
 * Shirt Size:  
                                                        
 * Sweatshirt
   Size:
 
                                                        
 
 
 * Employment
   Status: 
 
               
 * Current Number
  of Credits taking:
   
 
 * Type of
  Program:
   * Enrollment
  Status:
 
               
 
 
 Major:    GPA:
(Cumulative)
   ex. 3.25  
 
 * Why do you want to participate in a mentoring program?  
       
 
 * What do you hope to gain from joining
  Triton Undergraduate Men Pursuing Higher Education (TRIUMPH)?
 
       
 
 * Are you available to meet with a mentor four hours per month and
  have contact at least once a week for a minimum of one year?
 
                                                           
 
 
 * Please explain any particular scheduling issues.  
       
 
 * Tell us about yourself, what makes you a perfect candidate for TRIUMPH?  
       

 

 

 

Upon submission, this form will be transmitted to the Office of Student Life in room B-240
For questions, please call (708) 456-0300 ext. 3850