18-19 Success Mentor Program | Mentee Application
To be considered for the Success Mentor Program, please complete this application.
Email address *
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Student ID Number *
This can be found on your CatCard or at the top of your Portal (my.ucmerced.edu).
Your answer
UC Merced Email Address *
Your answer
Phone Number *
Please list a phone number that your mentor or SMP staff may reach you at.
Your answer
What is the best way for a Success Mentor to contact you? *
Select all that apply.
Required
What is your housing status for the fall semester? *
What is your major? *
Your answer
When is your birthday? *
MM
/
DD
Have you applied to join the Fiat Lux Scholars Program? *
Required
If you were provided an application code, please provide that code here:
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.