Name                                                              SS# 

Telephone Number (For Messages)       E-Mail Address 

Major      Emphasis     Minor 

Expected graduation date Click here19992000200120022003200420052006      Class level Click hereFreshmanSophomoreJuniorSeniorGraduate

Number of Units Currently Enrolled: Click here123456789101112131415161718+

What level are you expecting to teach and/or coach? Click hereElementaryJunior HighHigh SchoolJunior CollegeUniversity

Are you planning on attending a credential program upon graduation? Click hereYesNo
If so, when and where do you plan on attending?
When:                 Where: 

Are you interested in the following programs at SDSU?
    Adapted Physical Education Program Click hereYesNo
    Graduate School Physical Education Program Click hereYesNo
    Teaching Credential Program Click hereYesNo

What issues, topics, or ideas would you like to see addressed at our monthly meetings?
Please feel free to list any and all concerns of this regard below:

Are you interested in having a mentor through this program? Click hereYesNo
If you are a senior or graduate student, would you like to be a mentor? Click hereYesNo

What time would fit into your schedule for a one-hour meeting: (List times for each day)
Monday 
Tuesday 
Wednesday 
Thursday 
Friday 

Do you have any suggestions for our social function at the end of the semester? (When, Where, etc.)