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A.I.M. Application 21-22

A.I.M. Student Information

1. Name *This question is required.

First Name
Middle Initial
Last Name

2. Date of Birth (MM/DD/YYYY) *This question is required.

3. Y Number (YSU Banner ID)

4. Email Address *This question is required. This question requires a valid email address.

5. Home Address

Street
City
State
Zip Code

6. Cell Number *This question is required.

8. If you choose "Other" for Ethncity/Race, write it in

Please enter an 'other' value for this selection.

9. Interests/Hobbies *This question is required.

10. High School Attended

11. Year Graduated (YYYY)

12. GPA (X.XX)

13. I Identify my gender as...

14. Intended Academic Focus/Major *This question is required.

15. Are you committed to meeting with your Mentor regularly?

16. Are you committed to meeting monthly with other AIM students and Mentors in our Ally Circles Sessions?

17. Will you live in campus dorms or apartments?

18. Are you interested in working on campus?

19. Which would you prefer for a Mentor? *This question is required.

20. What is your t-shirt size?