Mentor Registration Form
ScienceM@tters is currently recruiting mentors for the upcoming Fall 2012 and Winter 2013 semesters. Mentors are welcome from any profession, industry or occupation, but should hold a Bachelor of Science from Memorial University and have been working at least 1 year. Interested individuals will be placed in a queue and, depending on the pool of students, will be asked to participate accordingly.

Name

Address

MUN email address

Phone Number

Major/Minor

Graduated in:

Gender:

Student #:

Current Job Description


Why are you interested in participating in the ScienceM@tters program?


How do you think the skills/knowledge you acquired through your Bachelor of Science from
Memorial University of Newfoundland assisted your career path?


Are there any community activities or interests you would like to share:


I'm real, this is NOT SPAM
I'm not real, this IS SPAM

Please direct further inquiries to:
Centre for Career Development, UC 4002
Email: sciencematters@mun.ca or Phone: 709 864 6236

Access to Information and Protection of Privacy
The information on this form is collected under the authority of the Memorial University Act (RSNL 1990 Chapter M-7) and is used for the purposes of program administration. Questions about this collection and use of personal information may be directed to the Office of the Dean, Student Affairs and Services at 709-864-7595.