EXCEL Program: Mentor Registration Form
Basic Information
Name:
PeopleSoft ID / Employee ID:
Department:
Major/Title:
Classification:
Sophomore
Junior
Senior
UH Faculty
UH Staff
Address:
City:
State:
Zip:
UH Mail Code (if applicable):
Phone:
Email:
Program Information
I would like to serve as a mentor to:
1 student
1 or 2 students
Up to 3 students
Up to 4 students
Optional Information
Gender:
Male
Female
Ethnicity:
African-American
American Indian
Anglo-Saxon
Asian/Pacific Islander
Hispanic
Other
For more information, contact the Dean of Students Office at 713-743-5470.
