UNH Non-Traditional Student Organization Membership Form

Name(First, Last) ....Birthday ......Gender: male female other

Local (Mailing) Address (street) (City)

..........................................(State ) (Zip Code)

Permanent (Street) Address( street) (City)

..........................................(State) (Zipcode)
Phone

Date of Enrollment at UNH ...........Expected Graduation Date

Major

Class standing:

Freshman Sophmore Junior Senior Grad

Admission Status

DCE Transfer Other

Optional: Single Parent yes no .........Veteran yes no ..............

E-mail Address ............ * Are you interested in joining the Listserv? yes no

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Your Partners Information (Optional)

Name (First, Last) Birthday UNH Student? yes no

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Your Children's Information (Optional)

Name Birthday

Name Birthday

Name Birthday

Name Birthday *************************************************************************

What do you hope to get out of this group?

What would help you succeed as a student?

Do you have any special talents or skills which you would like to contribute?

Would like to be assigned a mentor? yes no

How did you hear about us?