M.A.L.E.S. Application

First Name*

Middle Initial *

Last Name*

What is Your Gender Identification?

Female

Male

Non-binary/third gender

Prefer to self-describe

Prefer not to disclose

What is Your Ethnicity?

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other

Prefer not to disclose

What is Your Major?*If "undecided" respond "N/A"

What Is Your Classification/Status?

Freshman

Sophomore

Junior

Senior

Graduate/Professional Level

First Generation College Student (Parents did not attend college)

Yes

No

I am not sure.

Local Address*Number, Street ,City ,State & Zip Code

Mobile Number (Include area code)*(229)-903-1903

ASU Email Address (Primary)*

Preferred Email Address (Secondary)

Social Media HandlesInstagram, Twitter, Facebook

Special Interest/Talents*

Mentor Experience *if none, input "NA"

What do you feel you can bring to the MALES mentorship program?*

I would like to request a mentor.

Yes

No

I am not sure.

I want to be a mentor.

Yes

No

I am not sure.

I give the Office of Student Engagement/Associate Dean for Student Engagement permission to verify my university records for "good standing" for initial membership and continuity. I also agree that my educational pursuit is my number one priority. *type "yes or no" and the current date.

By submitting this application, I agree that the above information is true and accurate to the best of my knowledge and agree for its usage in MALES Mentors. I also understand my information will be used for review and selection into the MALES Mentoring Program.

M.A.L.E.S. Application

Thank you for expressing your interest in MALES.

Complete the below application for membership.