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OMD Peer Mentoring Services Mentee Application
UA students can submit this form to request a Peer Mentor.
Personal Info
First Name:
Last Name:
Middle Initial:
Primary Phone Number (555-555-5555):
UA Email Address:
I am a:
Select the option that best reflects your academic status based on accumulated credit hours.
First-Year Student
Sophomore
Junior
Senior
Intended major (list 'undeclared' if undecided):
Interests and Mentor Options
Activities that I enjoy, or am interested in (please select all that apply)
Reading
Community Service
Playing Sports
Movies/Theater
Writing
Travel
Watching Sports
Performing Music/Dance
Cultural Events
Religious Involvement
Video Games
Professional Clubs/Organizations
Other:
I would like my Peer Mentor to be:
Male
Female
I have no preference
Based on your availability, indicate as precisely as possible the best days for your advising/mentoring meetings to take place:
OMD is open Monday-Friday, 8am-5pm
Monday
Tuesday
Wednesday
Thursday
Friday
Best times for mentoring meetings
Please indicate your best times on each day that you selected in the previous question. If you do not know your upcoming semester's schedule, state so.
An asterisk (
*
) denotes a required field
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