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
Mentee 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 mentees?
Mentees are 1st year graduate students who are new to campus and want to feel more engaged and connected to
their academic program and more informed of existing campus and professional development resources. The
program is designed to help mentees enjoy their time at CSUN and excel in their program.
REQUIREMENTS AND SELECTION CRITERIA
Mentee Requirements:
 Completed application
 $200 stipend for participation
 Meet regularly with mentors
 Attend designated activities* throughout the academic year.
*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 (forthcoming),
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.
PROCEDURE FOR GRADUATE STUDENT APPLICANTS
1. Complete the Mentee Application Form (see form below).
2. Return all materials to camino@csun.edu or turn in to JD2500 Attn: Cathy Kitinoja no later than Friday,
September 11, 2015 at 5:00pm PT.
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 Mentee 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 enrolled in one of the aforementioned programs. 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: __________
*GPA: ___________
*Expected graduation date: __________
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
 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): ______________________________
*List any personal hobbies that would help us match you with a mentor (i.e. sports, reading, attending plays, etc.)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
*What are you looking for in a mentor?
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
*Which of the following areas apply to your mentoring needs? (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 ______________________________
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: _________________