College of Health and
Human Development
College of Health and Human Development’s United States Department of Education
CAMINO: Charting Access for Hispanics Majoring In Needed Careers and Occupations in Healthcare
Mentor Application 2015
PROGRAM DETAILS
Purpose
The purpose of the Hispanic Graduate Student Learning Community (HGSLC), also known as our peer
mentor program, is to help graduate students from CSUN’s allied health programs within the college of HHD
to build a community where they can access academic support, professional development, and servicelearning activities, as well as engage in peer mentorship with fun and rewarding networking opportunities.
Funding
This program is made possible by funding from CAMINO: Charting Access for Hispanics Majoring In Needed
Careers and Occupations in Healthcare, a United States Department of Education’s Promoting Post-Baccalaureate
Opportunities for Hispanic Americans (PPOHA) Program.
What is the peer mentorship program?
The peer mentor program pairs 2nd year/continuing graduate students with 1st year students from their respective
HHD graduate programs. Mentors are trained to guide their mentees through the academic year. Mentors help peer
mentees transition and feel more connected to the university in meaningful ways.
Who are the mentors?
Mentors are 2nd year or beyond graduate students who are dedicated to guiding others through their respective
programs. Mentors know how difficult it can be to take on the graduate student role and transition to the next level.
Mentors listen and guide their mentees through the academic year. Mentors serve as positive role models and
advocates, guiding students through the academic system, including workforce preparation. Mentors love what they
do!
REQUIREMENTS AND SELECTION CRITERIA
Mentor Requirements:
 Completed one year of graduate school and is in good academic standing, minimum 3.5 GPA
 Completed application
 One referral from a CSUN administrator, faculty or staff member
 Attend designated activities* throughout the academic year, as well as meet with and advise their mentees
 Will be paid $15/hr for 10 hours a week
*Activities include 2 CAMINO professional development workshops a semester, as well as CAMINO-affiliated
events such as the Leadership Speaker Series, network mixers, a local or regional conference, and/or participate in
graduate student association meetings.
Selection Criteria:
Students must be enrolled in a graduate degree in one of the following programs under the College of Health and
Human Development: Environmental and Occupational Health, Health Administration, Lactation, Gerontology,
Nutrition, Public Health, Kinesiology, Physical Therapy, and Communication Disorders. Priority will be given to
low-income and/or first-generation graduate students (meaning you are the first student to attend college within
your immediate family) and Hispanic/Latino students with a) professional experience or growth potential, b)
leadership, c) professionalism and maturity.
College of Health and
Human Development
PROCEDURE FOR GRADUATE STUDENT APPLICANTS
1. Complete the Mentor Application Form (see form below).
2. Complete the CAMINO Research Assistant/Peer Mentor Supplemental Application
3. Submit a current DPR and current resume including paid employment, volunteer, community service, or research
experience. Please emphasize if you are working, volunteering, or engaged in community service or research,
related to Latino/Hispanic populations.
4. One letter of recommendation must be provided. Letter must be from a full-time faculty member in your
program.
5. Return all materials to camino@csun.edu or turn into JD2500 Attn: Cathy Kitinoja no later than Friday,
September 11th 2015 at 5:00pm PT.
College of Health and
Human Development
College of Health and Human Development’s United States Department of Education
CAMINO: Charting Access for Hispanics Majoring In Needed Careers and Occupations in Healthcare
2015 Mentor Program Application
Please type or print the following information:
Criteria for Applying: According to the funder’s specifications, applicants must be low-income and/or firstgeneration students and currently. Please print clearly. Fields marked with an asterisk (*) are required.
*Name (First, Last, Middle):____________________________________________________________
* Semester _____________________
*Program _______________________
*CSUN ID# ____________________
*CSUN Email Address: ___________________________________________________
*Current Mailing Address: ____________________________________________________________
*Preferred Phone: ____________________________
*Date of Birth (MM/DD/YY): ____________________
*Gender:  Male  Female
*Total college or university units completed (for your graduate degree only):________________
*Total semesters at CSUN:______________
*Number of units needed to complete your requirements for graduation from CSUN: __________
*Number of units being taken this semester: __________
*Expected graduation date: __________
*GPA: __________ (must be at least a 3.5 for all graduate coursework)
Are you the first member of your immediate family to attend college?  Yes  No
Ethnicity (check all that apply):
 Asian/Pacific-Islander
 Black/African-American
 Hispanic/Latino
 Native American
 White: European Descent
 White: Middle Eastern Descent
College of Health and
Human Development
 Biracial/Multiracial
 Other (not included above): ______________________________
If you marked “Hispanic/Latino” above, please specify by checking any of the following that apply to you:
 Latino
 Spanish origin
 Chicano
 Mexican
 Mexican American
 Puerto Rican
 Cuban
 El Salvadorian
 Guatemalan
 Other (not included above): ______________________________
*Explain your reason for applying to be a peer mentor.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
*List your skills, abilities and experiences and how they relate to peer mentoring.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
*Why is it important for a first year student to have a good role model and mentor?
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
*List any personal hobbies that would help us match you with a new mentee (i.e. sports, reading, attending plays,
etc.)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
*Which of the following areas are you comfortable addressing? (Check all that apply)
Understanding requirements
 Following the graduate plan
Difficulties with academic program Balancing school and personal life
Being a parent/caretaker and student Professional Networking Opportunities
Completing comprehensive exams
 Completing a thesis
Financial issues
Internship Concerns
Finding employment post graduation Other
*How did you become aware of the CAMINO Peer Mentor Program?
CSUN Faculty Staff
CSUN Student
Family Campus Day
Word of Mouth
CAMINO website
Graduate Coordinator recommendation
Campus Advertisement (posters, flyers, etc.)
Other ______________________________
College of Health and
Human Development
*How many students would you be able to mentor?
 one (1)
two(2)
* You are required to attach a current copy of your DPR (Degree Progress Report) and current resume (all paid
employment, volunteer work and/or community involvement should be included in this document).
Statement of Authenticity and Participation
I certify that the above information is true and correct. I agree to provide, if requested, any official documentation
necessary to verify this information. I understand that false statements or misrepresentation on this form may result
in having to refund the scholarship amount if awarded.
Signature: ________________________________________________
Date: ___________________
College of Health and
Human Development
College of Health and Human Development’s United States Department of Education
CAMINO: Charting Access for Hispanics Majoring In Needed Careers and Occupations in Healthcare
Mentorship Letter of Reference Form
How long have you known this applicant?
_________________________________________________
What is your relationship to this applicant?
_________________________________________________
.
In considering this application for our scholarship, we solicit your candid evaluation of the applicant's academic
capability, research scholarship, leadership experience, and community service.
Superior
Good
Average
Poor
Academic/scholarly aptitude
Dependability
Maturity
Leadership
Professional attitude
Ability to express oneself in
writing and verbally
Ability to work with others
Research/scholarly capability or
experience
Service to the department
Service to the community
Dedication to or passion for the
profession
If possible, please also include a short narrative providing specific comments.
Recommender's Name: ____________________________________________________
Position/Title: ___________________________________________________________
Department/Program: ______________________________________________________
Signature ________________________________________
Date: _________________
Unable to Judge
College of Health and
Human Development
CAMINO Research Assistant/Peer Mentor Supplemental Application
Student Name:___________________________
Date:___________________
Are you currently employed on the CSUN campus? Y N
If yes, how are you employed?
As a research assistant? Y N
As a student assistant? Y
N
As a staff member? Y N
Other (please write in) __________________________________
How many hours do you already work for CSUN? ___________________
What college to do you work for? _________________________________
Which department?_______________________________
What grant?_______________________________
Name and contact information of direct supervisor of current position:
________________________________________________________
Start date of current position:____________ End date (if applicable)_______________