Peer Mentor Program – Mentor Application Disability Support Services (DSS) New Student Disability Support Services (DSS) – Current Student Peer Mentor Program - Mentor Application Full Name Check all that apply First generation student First time college student Traditional age college student Non-traditional age college student 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 Explain your reasons for applying to be a peer mentor* List your skills, ability and experiences as they related to mentoring* How can you help a first year student as a role model and mentor?* How do you describe your communication skills?* How do you describe your abilities to be an effective mentor?* Are there specific characteristics you would want us to consider in matching you with a mentee?* List any personal hobbies or enjoyable activities that would help us match you with a new student Describe any past or present leadership endeavors How many students would you consider mentoring? On what topics would you request additional training?* How much time per week do you expect to interact with your mentee?* What do you expect to gain from this experience?* Mentor Responsibility Agreement: The Peer Mentor Program provides for each student caring mentors who genuinely want to help a first time student succeed at CTC. The peer mentor is expected to understand college policy and procedure, academic support services, student support services, student code of conduct, and college services and resources. The Mentor responsibilities are as follows. As mentor, I agree: 1. To meet with my mentee at least three times a semester, beginning with an initial meeting within one week of being assigned a mentee 2. To contact my mentee once a week or on a regular basis by email, text, or phone call 3. To contact my mentee to find out if there are any obstacles or challenges that might hamper academic or personal success 4. To attend any peer mentor program meetings 5. That I understand that both peer mentor and mentee may not work effectively together for a variety of reasons; therefore, a mentor may be assigned to a different mentee or vice versa 6. To participate in program evaluations at the end of the term 7. To notify the program coordinator if any concerns arise in regard to mentoring a student I have read the above agreement and understand my obligations as Peer Mentor.* Acknowledged Electronic Signature* Signed Submit