Disability Services
Mason Autism Support Initiative
2016-2017 Academic Year
4400 University Drive, MS 5C9
Student Union Building 1, Suite 2500
Fairfax, VA 22030
Phone: (703) 993-2474
Fax: (703) 993-4306
TTY: (703) 993-2476
Email: ods@gmu.edu
Peer Mentorship Information
Thank you for your interest in becoming a peer mentor for students enrolled in the Mason Autism
Support Initiative program. Peer mentors play an extremely valuable role in providing individualized
support for students as they navigate through social and academic aspects of life at Mason. A mentor
maintains regular contact with a mentee throughout the academic year to promote a positive university
experience.
To be considered for selection as a peer mentor, the applicant must meet general requirements:











An undergraduate student
Minimum GPA 2.8
Provide two references who can speak to your ability to be an effective mentor.
Commit to a minimum of one academic year, 3 to 4 hours weekly.
Attend required bi-weekly supervision meetings and weekly groups (1 hour) according to
attendance policy.
Time and motivation to participate.
Solid social skills with awareness of personal strengths and weaknesses.
Active listening skills.
Ability to give thoughtful, sensitive feedback.
Check in regularly with mentee, at least 2 times per week.
Attend mandatory training sessions at the end of Spring and the beginning of the Fall semester
Timeline:





Application due via email March 3rd by 5:00pm
Interviews March 14th – 18th
Decisions emailed out March 22nd
Accept Decision by March 28th
Spring Intro to Autism Training sessions April 8th, 15th, 22nd, and 29th from 10-11am (*You
must attend ALL 4 training sessions)
 Mandatory UNIV class first 8 weeks of Fall semester Fridays 10:30am-12:20pm (You may opt
to take this class for 1 credit)
Page 1
Disability Services
Mason Autism Support Initiative
2016-2017 Academic Year
4400 University Drive, MS 5C9
Student Union Building 1, Suite 2500
Fairfax, VA 22030
Phone: (703) 993-2474
Fax: (703) 993-4306
TTY: (703) 993-2476
Email: ods@gmu.edu
Application for Peer Mentorship
Please complete the following information and submit this form to Christopher Williams at cwilli23@gmu.edu
Personal Information
Name:
Email:
Current Address:
Date of Birth:
Street
Age:
Male
Female
City
Phone Numbers
E-mail Addresses
Cell Phone:
GMU:
Alternate Phone:
Alternate E-mail:
State
Zip Code
@masonlive.gmu.edu
Major(s)/Minor(s):
Activities/Organizations you are involved/interested in
Arts
Honors
Religious
Cultural
Political
Representative Council
Service
Outdoors/Nature
Sports & Recreation
Greek Life
Academic/Professional
Other (please explain below)
Page 2
(Fraternity/Sorority)
Personal Information
Please describe yourself (where you are from, what you like to eat, your favorite places, etc.).
What are some of your most valued qualities or strengths?
What is an accomplishment you are proud of?
How do you enjoy spending free time?
What are some of your long-term goals (where do you see yourself in 5 or 10 years)?
What are your academic interests? General interests?
What are three personal qualities that would make you a good mentor?
Page 3
Why are you interested in this position?
Please describe any experiences you have had working with individuals with disabilities, particularly those with an
autism spectrum disorder.
Briefly describe any experiences you have had (academic, professional, and/or personal) that qualifies you for this
position
Please provide additional information that you feel would be important for us to know about you.
References (academic, professional, or personal)
Name:
Phone:
Relationship to applicant:
Email:
Name:
Phone:
Relationship to applicant:
Email:
Page 4
By signing below, I am agreeing to allow MASI staff at George Mason University to use this information as part of their application
process for selection as a peer mentor.
By signing below, I am certifying that the information on this application is accurately presented.
Signature
Date
Please email completed application and resume to
Christopher Williams at cwilli23@gmu.edu by 5:00pm
Thursday, March 3rd.
Page 5