Peer-Mentor Application
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Mentoring for Success - Peer-Mentor Application
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This is an electronic version of the Peer-Mentor Application for the Mentoring for Success program at Roxbury Community College. Please complete the application and fully answer all of the following questions as best you can. Any missing information could delay your application process.
The electronic application consists of 3 pages and you must complete the application in one sitting - if you exit the survey before you complete it, all progress will be lost and you will have to start over next time.
Thanks for your interest in being a Peer-Mentor with our program!
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. Personal Information:
Personal Information:
Name:
Date:
Phone (most easily reached):
Email:
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2
. Do you prefer to be contacted by email or phone? If no preference, please select both.
Do you prefer to be contacted by email or phone? If no preference, please select both.
Email
Phone
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3
. Please enter your date of birth:
Month
Day
Year
Birthday:
January (1)
February (2)
March (3)
April (4)
May (5)
June (6)
July (7)
August (8)
September (9)
October (10)
November (11)
December (12)
Please enter your date of birth: Birthday: Month
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31
Day
1994
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1960
Year
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. Gender:
Gender:
Female:
Male:
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5
. Are you:
Are you:
RCC Alumni
Current RCC Student
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. If you are an RCC alumna/almnus,
(Move to Question 7 if you are a current RCC student)
If you are an RCC alumna/almnus, (Move to Question 7 if you are a current RCC student)
Please enter your year and term of graduation (ex: Spring 2011):
Major/Concentration:
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. OR, if you are a current RCC student,
(skip to Question 8 if you are an RCC alumna/alumnus)
OR, if you are a current RCC student, (skip to Question 8 if you are an RCC alumna/alumnus)
this is currently your __ (#) semester at RCC (2nd, 3rd, 4th, etc)
Major/Concentration:
Student ID #:
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. Are you a first-generation college student?
(Neither of your parents have a higher education degree)
Are you a first-generation college student? (Neither of your parents have a higher education degree)
Yes
No
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9
. Why are you interested in participating in the Mentoring for Success program as a Peer-Mentor?
Why are you interested in participating in the Mentoring for Success program as a Peer-Mentor?
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10
. If applicable, please describe any previous mentoring experiences you have had, either as a Mentor or Mentee.
(Put "None" if necessary)
If applicable, please describe any previous mentoring experiences you have had, either as a Mentor or Mentee. (Put "None" if necessary)
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11
. What qualities, skills, strengths, or other attributes do you feel you have that would benefit a first-generation student at RCC? Please provide examples.
What qualities, skills, strengths, or other attributes do you feel you have that would benefit a first-generation student at RCC? Please provide examples.
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12
. Please share any clubs, student activities, athletic teams, Dean’s/President’s List, Honors, etc that you have been involved or associated with, if any.
(Put "None" if necessary)
Please share any clubs, student activities, athletic teams, Dean’s/President’s List, Honors, etc that you have been involved or associated with, if any. (Put "None" if necessary)
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