|
First Name
|
|
|
Last Name
|
|
|
OASIS ID Number
|
|
|
Street Address
|
|
|
City
|
|
|
State
|
|
|
Zip Code
|
|
|
Phone Number
|
|
|
Email
|
|
|
Would you prefer to be reached by phone or email?
|
Phone
Email
|
|
|
|
BACKGROUND INFORMATION
|
|
|
What is your living status going to be during the Fall 12 semester?
|
On Campus
Off Campus
At Home
|
|
Do you plan to work during the Fall 12 semester?
|
Yes
No
|
|
Are you available to attend Peer Support Program functions on Tuesdays between 12:00 – 1:00 p.m. during the semester?
|
Yes
No
|
|
How many hours per week do you plan on working?
|
|
|
READ AND CHECK BELOW:
Mission Statement
The Mission of the Peer Support Program is to increase the success and retention rates of first-year Columbia College Chicago students. The program connects first-year minority and other underrepresented students with upper-class peer mentors. Peer mentors coordinate opportunities for students to become acclimated to the campus and Chicago area, as well as to develop their personal, academic, social and cultural experiences through programming and guidance.
Mentee Expectations
* Must be a first-year student at Columbia College Chicago (Freshman or transfer student standing)
* Must complete an online application
* Must read and sign this mentee commitment form
* Must be willing to attend the following components of the Peer Support Program
* Attend the Peer Support Program Welcome Session
This will take place August 28, 2012 from 4:30 p.m. – 6:30 p.m.
* Attend FOUR “Tips on Tuesdays” Workshops from 12:00 – 12:45pm
- * September 13
- * September 27
- * October 11
- * October 25
- * November 8
- * November 22
- * December 6
* Must be in touch with your Peer Mentor at LEAST every two weeks (via email, phone, or in-person meetings)
* Must complete a confidential program evaluation online near the end of the semester
* Have a sincere interest in developing a relationship that supports your efforts toward graduation
* Demonstrate a commitment to carry out agreed upon goals and action plans
* Must update your contact information to both your peer mentor and the Program Coordinators when changes occur
|
|
By checking this box, I agree that I have read and understood all parts of this application form. I authorize the information shared above may be given to my Peer Mentor for program purposes only. I acknowledge all mentee expectations listed above and will strive to be an active participant in the Peer Support Program to the best of my ability.
|
|
|
|
PEER SUPPORT PROGRAM MENTEE MATCHING FORM
|
(Please share as much as you can to ensure a great match with your mentor.)
|
|
Major
|
|
|
Minor
|
|
|
Gender
|
|
|
Racial/Ethnic Background (optional)
|
|
|
What are your hobbies/interests?
|
|
|
What student organizations are you interested in?
|
|
|
What types of internships are you interested in?
|
|
|
What other aspects about yourself would be helpful to know to match you with a mentor?
|
|
|
Did one of your parents/guardians receive a college degree?
|
Yes
No
|
|
|
|
|
