Name (including maiden name if applicable):
Years attended UNT:
Member of UNT organizations:
Field of study:
Are you a business owner:
If yes, Business name & address:
Would you be willing to promote on the job training for UNT African American students through an internship program?
Briefly describe product/service that your business provides:
Would you be willing to be a mentor to an African American student at UNT?
If yes, in what field of study:
Are you a member of the UNT Alumni Association?
If yes, please provide your UNT Alumni Assoc. membership number:
Would you be interesting in working on the Homecoming Committee for 2013?
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