Today's date: 
Name (first and last): 
Student Citrus College ID Number: 
Are you:
Phone (include area code):
Email address: ex.

Which of the following courses have you completed (or are in the process of completion)? Check all that apply:

List your TOP THREE (3) CHOICES of Universities for transfer:

When do you intend to transfer? ex. Fall 2015 (if undecided, type "undecided")

When would you like to start working as a Mentor?
Please provide us with a Citrus College instructor (name and subject taught) who can offer details of your academic abilities and professionalism (punctuality, responsibility, etc.) if contacted by the SIGMA coordinator.

instructor's name, subject and grade received


(include clubs, organizations, or professional associations)

Other interests or hobbies:

Career goals:

Why do you think you will make a good mentor?