Jr Moxxie Student Mentee Application

Accepting applications through May 6, 2022.  All applicants will be emailed to set up a 15-minute Zoom interview to determine suitability to the program.

Personal Info

First Name:*
Last Name:*
Personal Email Address:*
School Email Address:*
Mobile Phone:*
Date of Birth:*
College Name:*
Graduation Month:*
Graduation Year:*
Home Address:*
Home City:*
Home State:*
Home ZIP Code:*
School Address:*
School City:*
School State:*
School ZIP Code:*

General Info

How did you hear about Jr Moxxie?

If other, please specify

Why do you want to join Jr Moxxie?

If other, please specify

Other than school, what are you involved in?

If other, please specify

Academic Info

College Major:*
College Minor:*
Outside of your major/minor fields, what academic subjects or industries are you interested in?*


Full and partial scholarships for the Jr Moxxie Mentoring Program may be available. Students receiving scholarships MUST fulfill all Jr Moxxie program requirements or may be asked to reimburse all or part of their Jr Moxxie scholarship money. If applying for a full or partial scholarship, please check the box below.
NOTE – this is NOT a scholarship for your school tuition – ONLY for the Jr Moxxie program.

Additional Comments

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