PEER MENTOR

APPLICATION

STEPS:

  1. Review information sheet for theiStart Smart College Success Peer Mentor Program.
  1. Complete this application form.
  1. Acquire an unofficial transcript from PVCC (and any other college you have attended).
  1. Submit all application materials to either Marianne Roccaforte or Marianne Auten at the PVCC Counseling Division in the KSC Building.

PEER MENTOR APPLICATION

PART I: STUDENT INFORMATION

PLEASE PRINT CLEARLY. Attach a separate sheet of paper if you need more space.

Your Name
College Success Course Completed / Circle one: AAA115CPD150
Semester completed: Grade earned:
PVCC Student ID
Mailing Address, with City, State, Zip
Full Email Address
Cell Phone
(w/area code)
Home Phone
(w/area code)
Possible College Major
Possible Career Goal
All Colleges/Universities Attended
Cumulative GPA(current)
Credits Completed (by end of this semester)
Credits Enrolled next semester (expected)
What are three words that would describe you?
How did you find out about Peer Mentor Program?

PEER MENTOR APPLICATION

PART II: SHORT-ESSAY QUESTIONS

Please hand-write neatly your responses to the following three questions (or type separately and attach to your application form).

What have been the most positive aspects of your college experience? What personal qualities and/or outside influences have helped you to succeed?

Why are you interested in becoming a Peer Mentor? How does this course relate to your career goals?

What experience, knowledge, skills, or personal qualities do you possess which you feel could benefit first-year (new or re-entry) PVCC students?

PVCC PEER MENTOR PROGRAM

PEER MENTOR PLACEMENT PREFERENCES

PEER MENTOR APPLICANT’S NAME (please print)

AAA115 or CPD150 INSTRUCTOR(S) WITH WHOM YOU WOULD LIKE TO WORK (NOTE: if schedules permit):

I am interested serving as a Peer Mentor with the following groups of students, if available(check any or all that apply):

______AAA115 class (1-credit Creating College Success)

______CPD150 class (3-credit Strategies for College Success)

______First-Year Experience (FYE) Learning Community

______ACE Bridge/college-preparatory program for high school students

______Student athletes

______Honors Program students

______Other special interests (specify)

Fall 2009 days/times during the week (including Saturdays) that I can be available to attend weekly class sessions and serve as a Peer Mentor in an assigned AAA115 or CPD150 class:

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