Project IMPACT: Men of Color Network Application
This application is for the opportunity to serve as a mentor to one of our many scholars in our Project IMPACT Program. If you have any questions about the process, or about the submission of your application, please reach out to ProjectIMPACT@rowan.edu. Thank you!
Name and Personal Information
First and Last Name: *
Your answer
Date of Birth: *
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Permanent Address (Street, City, State, ZIP):
Your answer
Email Address: *
Your answer
Day Time Phone Number (xxx-xxx-xxxx): *
Your answer
Evening Phone Number (xxx-xxx-xxxx):
Your answer
Employment Information
Current Position/Title: *
Your answer
Name of Educational Institution/Company: *
Your answer
Work Address: *
Your answer
Additional Information:
Why do you wish to take on this role? *
Your answer
What do you hope to accomplish through your role as a Mentor? *
Your answer
Will you be available to attend MOC meeting on the first Saturday of every month? *
Are you available to communicate (via email, phone, text, in-person, etc.) with your IMPACT Scholar at least twice a week? *
What experiences and/or opportunities do you feel you can share with our IMPACT Scholars through your role as a Mentor? *
Your answer
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