CAP Connection Student Registration
Student Information Form

Items with an * indicate a required field.
First Name *
Last Name *
E-mail address *
Phone *
Address Line 1 *
Address Line 2 *
City *
State *
Zip *
Which academic program are you in? *
What academic year are you?
Have you participated in the CAP Connection mentor program previously? *  Yes
  No
If so, who was your assigned mentor?
Do you wish to remain with this mentor?  Yes
  No
Do you have access to a vehicle?  Yes
  No
What are your personal interests, activities and hobbies?
 
What are the top 3 types of projects you are interested in?
1st *
2nd
3rd
 
What are the top 3 work duties you are interested in?
1st *
2nd
3rd
What are your professional interests?
Please feel free to list any additional information that will help in the matching process.