Please answer the following questions. You may submit your responses in writing
(to Ms. Erica Houston, Executive Assistant Division of Social and Behavioral
Sciences) or via email (lschulte@xula.edu) by May 1.
Name: _________________________________________________________________________________________
Cell Phone Number: _________________________________________________________________________
Email Address: _______________________________________________________________________________
Classification (e.g., sophomore, junior) in fall: ______________________________________
1. Will you be employed in the Fall (yes or no)? ________________________
2.
If you answered yes to the question above, approximately how many
hours per week will you be working? ____________________
3. Please list the campus activities and/or any organizations that you will be
involved in in the fall. For each activity/organization, please indicate
whether you hold an office.
Campus Activity/Organization
Office (e.g, president, treasurer)
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Please Continue to Side 2
4. How many credit hours will you be/are you planning on taking next
semester? _____________________
5. How many hours (per month) will you be able to commit to peer
mentoring? ____________________________________
6. Why are you interested in becoming a mentor?
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7. What qualities will you bring to the mentorship relationship?
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