| Name: |
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Email: |
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| PSU ID Number: (e.g. 912345678) |
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Birthday: Month
Day
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PSU Address:
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| City: |
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State:
Zipcode:
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Permanent Address:
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| City: |
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State:
Zipcode:
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| Cell Phone: |
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Semester Standing: |
| Major: |
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GPA: /4.0 |
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Anticipated Graduation Date:
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| Email: |
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T-shirt size (select one):
S
M
L
XL
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Application for:
PREF
ASE
MEPO
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MEPO (if selected above) (Please rank in order of preference (1, 2, 3; '1' is most preferred)):
*Please read position descriptions and requirements before selecting desired positions!
Lead Mentor
Lead Program Assistant
Program Assistant
Scavenger Hunt Activity Lead
Computer Workshop Lead
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Have you previously participated in any MEP programs as a participant, PA or Mentor?
Yes
No
How?
Participant
Mentor
Program Assistant
When? (Year)
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Are you a Schreyer Honors College student?
Yes
No
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Are you an International student?
Yes
No
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Will you be attending PSU in Fall 2009?
Yes
No
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Did you start at a PSU Campus?
Yes
No
Which campus?
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Are you a co-op/internship student?
Yes
No
Which companies have you worked for?
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Were you a study abroad student?
Yes
No
Where did you go?
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Describe your involvement throughout the year and how it has impacted your undergraduate experience (NSBE,
SHPE, PMP, volunteer, other). (Non Mentors Only)
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Why are you interested in serving as a MEPO Leader? (Non Mentors Only)
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What are your career goals? (Non Mentors Only)
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| Mentors |
Why are you interested in serving as a MEPO Mentor? (Mentors Only)
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Describe any relevant leadership experience that would help you in this position (Organization
officer, employment, etc.). (Mentors Only)
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Describe your involvement with the MEP Office throughout the year and how you have benefited
from their programs (ASE, PREF, VIEW, AEC, etc.). (Mentors Only)
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Return a copy your RESUME and a Reference Letter to:
Office of Engineering Diversity
Multicultural Engineering Program,
MEP0 2009
208 Hammond Building
University Park, PA 16802-1401
OR:
FAX: 814-863-7496
Email: mep@engr.psu.edu |
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