Jr Moxxie Mentee Application Applications for the Fall 2021 / Spring 2022 program are due by August 31, 2021.
Personal Info First Name:* Last Name:* Personal Email Address:* School Email Address:* Mobile Phone:* Date of Birth:* College Name:* Graduation Month:* January February March April May June July August September October November December Graduation Year:* Home Address:* Home City:* Home State:* 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:* School Address:* School City:* School State:* 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:* General Info How did you hear about Jr Moxxie? SchoolStudentSocial MediaOther If other, please specify Why do you want to join Jr Moxxie? Get a MentorGain ConfidenceAttend Field TripsObtain Internship/JobLearn BusinessDetermine a Career PathLearn/Develop a NetworkOther If other, please specify Other than school, what are you involved in? JobInternSportsClubOther 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?* Scholarships 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. I'd like to apply for a scholarship. Additional Comments Submit Cancel