PEER MENTOR
APPLICATION
STEPS:
1. Review information sheet for the iStart Smart College Success Peer Mentor
Program.
2. Complete this application form.
3. Acquire an unofficial transcript from PVCC (and any other college you have
attended).
4. Submit all application materials to either Marianne Roccaforte or Marianne
Auten at the PVCC Counseling Division in the KSC Building.
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PEER MENTOR APPLICATION
PART I: STUDENT INFORMATION
PLEASE PRINT CLEARLY. Attach a separate sheet of paper if you need more space.
Your Name
College Success
Course Completed
Circle one:
AAA115
Semester completed:
PVCC Student ID
Mailing Address,
with City, State, Zip
Full Email Address
Cell Phone
(w/area code)
Home Phone
(w/area code)
Possible College
Major
Possible Career Goal
All Colleges/
Universities Attended
Cumulative GPA
(current)
Credits Completed (by
end of this semester)
Credits Enrolled next
semester (expected)
What are three words
that would describe
you?
How did you find out
about Peer Mentor
Program?
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CPD150
Grade earned:
PEER MENTOR APPLICATION
PART II: SHORT-ESSAY QUESTIONS
Please hand-write neatly your responses to the following three questions (or type separately and
attach to your application form).
What have been the most positive aspects of your college experience? What personal qualities
and/or outside influences have helped you to succeed?
Why are you interested in becoming a Peer Mentor? How does this course relate to your career
goals?
What experience, knowledge, skills, or personal qualities do you possess which you feel could
benefit first-year (new or re-entry) PVCC students?
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PVCC PEER MENTOR PROGRAM
PEER MENTOR PLACEMENT PREFERENCES
PEER MENTOR APPLICANT’S NAME (please print)
AAA115 or CPD150 INSTRUCTOR(S) WITH WHOM YOU WOULD LIKE TO WORK (NOTE: if
schedules permit):
I am interested serving as a Peer Mentor with the following groups of students, if available (check any or all
that apply):
______AAA115 class (1-credit Creating College Success)
______CPD150 class (3-credit Strategies for College Success)
______First-Year Experience (FYE) Learning Community
______ACE Bridge/college-preparatory program for high school students
______Student athletes
______Honors Program students
______Other special interests (specify)
Fall 2009 days/times during the week (including Saturdays) that I can be available to attend weekly class
sessions and serve as a Peer Mentor in an assigned AAA115 or CPD150 class:
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