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HAWK Mentor Application
Section One: General Information
Name
Address
How long have you lived at this address?
If less than 5 years, please list previous addresses
Date of Birth
Home Phone
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Mobile Phone
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Email Address
Do you prefer text or email?
- Select -
Text
Email
Race
please mark all that apply
African American/Black
Asian/Pacific Islander
Caucasian/White
Native American/American Indian
Other
Are you Hispanic or Latino?
- Select -
Yes
No
Marital Status
- Select -
Single
Married
Children?
- Select -
Yes
No
N/A
Names of Children
Did any of your children attend the University of Kansas?
- Select -
Yes
No
Section Two: Education Information
Undergraduate College/University
Major(s)
Minor(s)
Undergraduate Graduation Date
Graduate College/University
Graduate Degree Earned
Graduate Degree Date
Section Three: Employment Information
Are you employed?
- Select -
Yes
No
If no, are you retired?
- Select -
Yes
No
Occupation
Employer Name
Title
Work Phone
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Work Fax
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Work Email
Photo Release Statement
Do you agree to the terms of the Photo Release Agreement?
- Select -
Yes
No
Submit Form
