LINC Peer Mentoring Registration Form

Please print your information on this form and return it to the Multicultural Student Programs Office in the Holmes Student Center, room 51 to register for the LINC program.  Questions?  Call (918) 631-2327 or email linc@utulsa.edu. 

Name (Last, First, Middle) Name Preferred

Contact information.  Place a * by the phone number you prefer for contact during the first week of classes.

Home Address (Street, City, State, Zip)

Home phone (w/Area Code)

On-Campus address (if known)

Campus Phone

Cell Phone E-Mail

Personal Information. Help us get to know you so that we can match you with a peer mentor.

Birth date         I am... Male Female

Ethnic Group(s). Mark all that apply.
Black Asian Hispanic Native American Other please specify:

Major/Minor(s):

Are you considering going to graduate or professional school?
Yes No

If yes, in what field?

Do you speak any foreign languages?
Yes No

If yes, please specify:

Please tell us about your interests, talents, and hobbies:

Please tell us your expectations of the program. What do you hope to gain by participating?

Preferences for matching. Please rank the following factors in matching you with a mentor. If a factor is unimportant to you, feel free to leave it blank. If an important factor is not listed, please write it in the blank for additional preference factors.

I would like to be matched with a mentor who shares my...

Major      Ethnic Origin      Interests      Experience as a student athlete      Gender

Additional preference factors:

We will do our best to match you to a mentor who fits your preferences.

How did you learn about LINC?

Submit form electronically by selecting the Submit button or mail to:
Laura Allen, 51 Holmes Student Center, 800 S. Tucker Drive, Tulsa, OK  74104