Jr Moxxie Mentee Application We will be accepting college student applications for the Fall 2024/Spring 2025 program in March 2024.
Personal Info First Name:* 25 characters max * Required Last Name:* 75 characters max * Required Personal Email Address:* 125 characters max * Required * Invalid email School Email Address:* 125 characters max * Required * Invalid email Mobile Phone:* 25 characters max * Required Date of Birth:* * Required Invalid Date College Name:* 75 characters max * Required Graduation Month:* * Required January February March April May June July August September October November December Graduation Year:* 4 characters max * Required Invalid Year Home Address:* 125 characters max * Required Home City:* 75 characters max * Required Home State:* * Required Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Minor Outlying Islands Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Home ZIP Code:* 5 characters max * Required School Address:* 125 characters max * Required School City:* 75 characters max * Required School State:* * Required Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Minor Outlying Islands Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming School ZIP Code:* 5 characters max * Required General Info How did you hear about Jr Moxxie? School Student Social Media Other If other, please specify Why do you want to join Jr Moxxie? Get a Mentor Gain Confidence Attend Field Trips Obtain Internship/Job Learn Business Determine a Career Path Learn/Develop a Network Other If other, please specify Other than school, what are you involved in? Job Intern Sports Club Other If other, please specify Academic Info College Major:* 150 characters max * Required College Minor:* 150 characters max * Required Outside of your major/minor fields, what academic subjects or industries are you interested in?* * Required Program Cost All accepted students will receive a full scholarship into the Jr Moxxie program. There is no program cost to you, your family or your school. Please note that this is NOT a school scholarship. Accepted students must fulfill program requirements – see attached Mentee Agreement Additional Comments Submit Cancel