Name:
Student ID:
Phone: Home Cell Business
Email address: Personal Business
Class standing:
Academic college:
Major:
Student groups:
Special interests:
How soon would you like to arrange your meeting? 3-4 weeks next month as soon as possible no preference
Which days of the week are generally best for you? Monday Tuesday Wednesday Thursday Friday
During which hours are you available to meet? weekday mornings weekday afternoons weekday evenings weekend mornings weekend afternoons weekend evenings
Where would you prefer to meet?
Please briefly describe your professional goals and interests.
What do you hope to gain from this experience?
How did you hear about SavorUB?
Were you referred to the program? If yes, by whom were you referred?
