International and Exchange Student Centre

INTERNATIONAL PEER CONNECTION (IPC) PROGRAM

PEER GUIDE Application Form2016-2017

First Name: (Ms./Mrs./Mr.)______Last Name: ______

Preferred Name: ______Student #:______

Please indicate your e-mail of preference:

UWO E-mail: Alternate E-Mail: ______

Telephone #: ______

Faculty: ______ Major: ______

Undergraduate: _____ Graduate: _____ Current Year in Program: _____

Please answer the following questions, using extra paper if necessary.

  1. Why are you interested in this program, and what do you hope to gain from it?
  1. What do you see as the role of the Peer Guide?

Please turn over

  1. Describe any experience(s) you have had in cross-cultural settings (for example living, studying or working in a different culture, etc.). Please elaborate (e.g., nature of experience, duration, etc.).
  1. What did you learn or gain from your cross-cultural experience(s)?
  1. Describe any previous experiences where you utilized helping, communication and leadership skills.

Please turn over

  1. Relate any additional skills, experiences (paid or volunteer work, extra-curricular activities, etc.), achievements, or add any other information pertinent to the role of a Peer Guide for International Students.
  1. List 3 programs and/or services offered by the International and Exchange Student Centre (IESC). Write one sentence for each program/service explaining how it supports international students at Western.
  1. List 3 services available at Western University, other than those at the IESC, that offer support to international students. Write one sentence for each service explaining how they support international students.
  1. What other commitments (e.g., part-time work, soph, residence staff, professional school (Ivey, Law, Medicine, Dentistry, etc.), grad school applications, preparing for professional/grad school exams (MCAT, DAT, LSAT, GRE, etc.), clubs, committees, etc.) do you expect for the upcoming academic year?
  1. What is your academic average for your year(s) at university? ______%

Please submit this application form by e-mail to

with the subject “Peer Guide Application.”

Note: Applicants mayinclude a copy of their resume and/or letters of reference. They may also be dropped off at Western International, International and Graduate Affairs Building, 2nd floor.

This application form is also available online at: