Peer Mentor Program – Mentee Application Disability Support Services (DSS) New Student Disability Support Services (DSS) – Current Student Peer Mentor Program - Mentee Application Full Name Questions? Call 770-975-4152 Program Information Check all that apply First generation student First time college student Traditional age college student Non-traditional age college student Student ID # Semester Street* City* State* Zip* Cell Phone* If checked, you authorize texting* Authorized Home Phone* Personal Email Address CTC Email Address* Best contact method Program of Study First semester?* Campus Location(s)* Other college attendance? Class Time/Day Class Time/Day Class Time/Day Class Time/Day If you work, how many hours per week? Career/Education Goals* Hobbies* Favorite Sports* Other Activities Are there specific characteristics you would want us to consider in matching you with a mentor?* What do you expect to gain from this experience? What particular challenges do you face upon entering college?* What do you want most help with?* Which of the following student services or resources are you most interested in? Select Tutoring Time Management Organization Student Support Services Career Services Career/Personal Counseling Stress Management Career Assessment Study Skills Community Resources College Resources Other If Other* Mentee Responsibility Agreement: The Peer Mentor Program provides each student an encouraging and caring mentor, prompts to utilize and engage in academic support services such as the Success Center, library, career services, academic advising, campus and college activities, and a the introduction of possible workshops which focus on developing or enhancing strategies for success. In addition, these are the responsibilities and expectations of the student mentees. As mentee I agree: 1. To attend all required classes, understand the syllabus, and meet all academic deadlines 2. To contact my mentor to make him/her aware of any obstacles which might hinder academic success. 3. To contact instructors or support staff prior to withdrawing from any class(es). 4. To meet with a tutor in the success center when an instructor or mentor recommends tutoring. 5. To attend meetings and activities scheduled by the Peer Mentor program. 6. To let my mentor know when I am experiencing academic or personal difficulties. 7. To be prompt and keep scheduled appointments with my mentor. 8. To participate in program evaluations and follow-up as requested by my mentor or the coordinator of the Peer Mentor Program. 9. I understand that I may request to be assigned a different mentor if my current mentor and I cannot work effectively together as a team. I have read the above agreement and understand my obligations as Peer Mentee.* Acknowledged Electronic Signature* Signed Submit