Mentor Interest Form

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Name(Required)

First Last

Email(Required)

Phone(Required)

What is the best way to reach you?(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Were you a first-generation student?(Required)

Yes

Company or organization you represent.(Required)

What is your title?(Required)

What best describes your position?(Required)

Please explain why you would like to be a mentor. What do you hope the student takes away from having you as a mentor?(Required)

Mailing Address
KHEDF
PO Box 4248
Wichita, KS 67204

Office
KHEDF
2601 N. Arkansas
Wichita, KS 67204

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