Peer Service Mentor Application Form Student Name __________________________________ Please briefly answer the following questions and email your application to honors@und.edu 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.)