Peer Mentee Application
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REQUIRED FIELDS
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Name:
Ethnicity (
optional
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School/Campus Phone: ex. (xxx) xxx-xxxx
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Local or School Address: (Street, Route, or Box Number)
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City:
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State:
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Zip Code:
Most communication for the Peer Mentor Program is done via email. Please indicate the email address that you check most often.
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Email Address:
GPA:
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Major:
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Classification:
NSU Extracurricular Activities:
High School Extracurricular Activities:
Supporting Information
1.
Have you participated in the STARS Peer Mentor Program ?
Yes
No
2.
If so, please indicate how you were assigned your Mentor
Through my department
Referred by an Instructor/friend etc.
I did not have a Mentor
6.
What career/occupational goals are you interested in pursuing upon graduation?
7.
Additional Information: Use the space below to make any additional comments.