Peer Service Mentor Application Form

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Peer Service Mentor
Application Form
Student Name __________________________________
Please briefly answer the following questions and email your application to
[email protected] by Monday, February 29, 2016.
Use this form to document your Civic Engagement in college. Think broadly of all the ways
you’re working to have a positive impact on the world around you.
CE-Related
Coursework
Government/
Politics
Organizations
Service/
Volunteering
Title of Project/
Organization
Role/Description of Work
Completed
Campus?
Local?
State/Regional?
National?
International?
Time Span of
Involvement
Appx.
Hours
Committed
Do you have leadership experience, including but not limited to teaching or
mentoring? If so, please explain.
Why is civic engagement or service important to you?
Why do you want to be a service mentor?
Anticipate the number of years you are able to commit to being a PSM, including
working with a first-year class in the fall, hosting the Civic Engagement Kickoff,
and meeting one-on-one and in groups with your mentees. (PSM terms run from
March to February.)
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