First Name * Last Name * Email Address * Preferred Phone Number * Preferred Phone Contact Method Business Cell Work Alternate Phone Number Alternate Phone Contact Method Business Cell Work Street Address Street Address Line 2 City State / Province / Region ZIP / Postal Code Did you earn an undergraduate degree at UK? Yes No Campus Location Lexington Paducah Are you a returning mentor or new to the program? * Returning Mentor New Mentor What was your undergraduate engineering major? Biomedical Biosystems Chemical Civil Computer EN Computer Science Electrical Engineering Technology Materials Mechanical Mining Other If other, what was your major? If returning, would you like to remain with your current student(s)? Yes No Student name(s): What year did you receive your undergraduate degree? I am a returning mentor and the following information has not changed since the previous application. * Yes No If your answer is yes, please review the Mentor Handbook and skip down to the SUBMIT button on this application. Geographic Regions in which you've resided New England: CT, ME, MA, NH, RI, VT Mideast: DE DC, MD, NJ, NY, PA Great Lakes: IL, IN, Ml, OH, WI Plains: IA, KS, MN MO, NE, ND, SD Southeast: AL, AR, FL, GA, KY, LA, MS, NS, SC, TN, VA, WV Southwest: AZ, NM, OK, TX Rocky Mountain: CO, ID, MN, UT, WY Far West: AK, CA, HI, NV, OR, WA Outside US Have you earned one or more graduate degrees? Yes No If yes, what is the Graduate Degree and Graduation Year? Activities as an Undergraduate Athletics/Cheerleading/Club Sports Engineering Student Council Engineering Organizations Greek Life Marching Band UK Student Government Residence Life ROTC Study Abroad Undergraduate Research Other If you participated in Engineering Organizations, which ones: If you participated in Other organizations, please list them Current Employer Current Position Title Area of Expertise/Industry Sectors AgricultureAutomotiveAerospaceBiomedical EngineeringChemical EngineeringCivil EngineeringComputers, Software, Information TechnologyComputer ScienceConsultingConsumer GoodsConstructionData, StatisticsDesign EngineeringEducationElectronicsElectrical Computer EngineeringEnergy, Gas, Oil, ElectricEngineeringEntrepreneur, Business OwnerEnvironmentalFinancial ServicesGovernment, DefenseIndustrialLawManagementManufacturingMaterialsMechanical EngineeringMedical DevicesMedicine, HealthcareMining EngineeringPharmaceuticalsSound, CommunicationsStructuresTransportation, LogisticsOther (Please describe below) Which area would you prefer your match to be based on? Undergraduate Major, Interest Home/Permanent address Geographic Region of Interest Student Involvement, Activities Ethnicity, Gender Industry Sector of Interest Would you be willing to mentor more than one (1) student? Yes No If you would be willing, how many? I verify that I have read the Mentor Program handbook and agree to the expectations outlined. Yes Leave this field blank Submit