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:* 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?* 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