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California State University, Long Beach
Partners for Success. Faculty Mentoring Students
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Student Application

Partners for Success

If you wish to participate in Partners for Success, please complete this form with a written statement of interest.

Name:
Identification Number:
Major:
Mailing Address (line 1):
(line 2):
Permanent Home Address (line 1):
(line 2):
Home Phone:
Work Phone:
E-mail Address:
Ethnicity (optional):
Gender:
 Female
Male
Class Level:
Freshman
Sophomore
Junior
Senior

Does your mother or father have a bachelor's degree? Yes No

Does your sister or brother have a bachelor's degree? Yes No

Do you have a gender preference for a mentor? Female Male No preference

How did you learn about the Partners for Success program?


Please write a statement of interest explaining why you would like to participate in Partners for Success.