HTML Preview Peer Mentor Application Form page number 1.
Peer Mentor Program Application
All applicants must fill out the application page, complete the questions, and have 2 references.
Name:
Campus Address: Campus Phone:
Cell Phone: Lee Email:
Home
Address:
Street City State
Zip Code
CIRCLE ALL OF THE FOLLOWING THAT WILL APPLY TO YOU FOR THE SPRING OF 2016:
SOPH JR SR On-campus Off-campus
Commuter
Cumulative GPA:
(Minimum 3.0 GPA required)
Major(s):
Minor(s):
Were you a transfer student?
YES
NO
List activities in which you have been involved with while attending Lee (participation and offices held):
List other jobs you may be working (on & off campus):
Anticipated activities/employment for the fall 2016 semester (be sure to include student teaching, sports,
internship plans, student organizations, on and off-campus employment, etc…):
Name of persons (and their department) completing reference forms for you: (MUST be 1 Lee faculty and 1 Res. Life
staff member):
The information above is correct to the best of my knowledge. If selected, I will return to campus to participate in PM
training. I have read and understand all of the material enclosed within this application packet and acknowledge that I
will carry out the Peer Mentor responsibilities to the best of my ability.
Signature
Date