SURGE banner



 * = Required Field
 * Semester:  

 * Year:  
 * First Name:      * Last Name:    M.I.:  
 * Date of
   mm/dd/yyyy  * Racial
 * Phone
  999-999-9999  * Email
 * Shirt Size:  
 * Sweatshirt
 * Employment
 * Current Number
  of Credits taking:
 * Type of
   * Enrollment
 Major:    GPA:
   ex. 3.25  
 * Why do you want to participate in a mentoring program?  
 * What do you hope to gain from joining
  Sisterhood of Undergraduate Representing Great Excellence (SURGE)?
 * 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 SURGE?  




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