FastStart Altoona

Professional Mentor Application

Please fill out the form completely. If you have any questions or problems, please contact the office of Institutional Equity and Diversity at 814-949-5053.

First Name:
Middle Name:
Last Name:
Preferred Name:
Date of Birth:
Sex/Gender:
Ethnicity (Optional):
Title:
Department:
T-shirt Size:
Mailbox Location:
Office Physical Location:
Office Hours:
Email Address:
Campus/Local Phone:
Cell Phone (Optional):

Favorite Books:

Favorite Television Shows/Movies:

Favorite Foods:

Hobbies:

Music Interests (Genre or favorite artists):

Sports Interests (indicate whether you watch or play):

What else do you do in your spare time?

What are your academic strengths/area of expertise?

What would you like to gain from participating in the FastStart program?

Security Code: 74528