Last Name:    First Name:    MI:

Gender: Female Male   

Major:    Minor:   GPA:

Academic status for 2008-2009 academic year:  Sophomore    Junior    Senior

Mailing Address:    City:    State:   Zip:

Home Phone #:    Cell Phone #:

High School:     Email Address :

What personal characteristics and skills do you possess which
would make you a good Peer Mentor?

Why are you interested in becoming a Peer Mentor?

Please list any student organizations or extracurricular activities
in which you plan to be involved during the 2008-2009 academic year:

What are your Hobbies/Interests?