Student Application
(Due September 16, 2005)

The Statistics Professional Mentoring Program is an opportunity for students in the Department of Statistics to develop their professional skills outside of the classroom through the guidance of a professional in the community. Students participating in this program are not only introducing themselves to the professional world, but also representing North Carolina State University to its Alumni and Friends. As a result, we have high expectations for the students who choose to participate in this program. It is important that you carefully read the below expectations to determine if you will be able to make the necessary commitments needed to make the mentor/student relationship a success.

1. Attend the Mentorship information Session early fall semester.
2. Attend the Orientation Kick-Off event held in September.
3. Initiate regular contact with your mentor via phone, email and/or meetings.
4. Meet your mentor at least once a month.
5. Act in a professional manner at all times.
6. Return phone calls and email correspondence in a timely fashion.
7. Complete program evaluations when appropriate.
8. Contact the Professional Mentoring Program Coordinator, Leigh Ann Thomason, if circumstances require you to stop participation in the mentorship program or if your mentor is not fulfilling his/her responsibilities.
By completing the form, I am indicating my willingness to participate as a student in the Statistics Professional Mentoring Program. I have read the above expectations and understand my responsibilities as a participant in the program. I am also aware that I will learn of my mentor match status at the Orientation Kick-Off and that I may be removed from the program if I am failing to participate.

If you agree to these terms, please sign here.

Last Name:

Fall 2005 Local Address:

City:

State:

ZIP:

Telephone:

Email:

Statistics degree you are currently working towards (circle only one):
Undergraduate
Masters
PhD

Year in School (if applicable):
Freshman
Sophomore
Junior
Senior

GPA:

Planned Graduation Date:

UNDERGRADUTE STUDENTS ONLY
If you are considering/working towards a second major (other than statistics), what major is it?

If you are considering/working towards a minor (other than statistics), what minor is it?

GRADUATE STUDENTS ONLY
What concentration are you considering/working towards?

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Have you participated in the Statistics Professional Mentoring Program before?

If yes, do you prefer to be matched with your previous mentor?

Previous mentor name:

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Select up to four career areas you are interested in pursuing (1 = most interested, 4 = least interested).

Government (Federal, State, & Local)
Automotive Industry
Public Relations Field
Educational Services
Environmental Field
College Professor
Public/Private School Teacher
Biopharmaceutical Industry Research & Development Firms
Medical Field
Market Research Field
Pharmaceutical Research Firm
Insurance Company
Computing Industry
Engineering Industry
Other

List activities you have been involved in (volunteering, student organizations, etc.).

List the top three things you would like to accomplish or learn from your mentoring relationship.

Describe your career goals and interests.