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?*

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

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