Peer Mentorship Application Form

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Peer Mentorship Application Form

Welcome to the CCIE Peer Mentorship Program 2025-2026 Application!
How many academic quarters have you completed at Highline College?*

0 (this is my first quarter)1234+Transfer student (first quarter at Highline)

You are eligible to be a peer mentor!

Our program is guided by three core values:
- Affirm Identity: Exploring the complexity of intersecting identites while empowering their authentic selves.
- Build Community: Giving students the opportunities to create meaningful relationships with diverse communities on campus.
- Cultivate Leadership: Providing students different leadership opportunties/roles so students can explore what leadership is for them.
Note: Please submit your application by October 27th, at 11:59 PM.

Personal Information:

Please provide your personal details for identification and communication purposes.
First name*
Last name*
Student ID number*
Email*
Primary telephone number
Birthdate
What is your gender identity?*

FemaleMaleNon-binaryPrefer not to sayOther

Extracurricular Activities

Please provide a brief overview of your involvement in activities outside of the classroom.
Activity 1*
Activity 2
Activity 3
Achievements

As a peer mentor in the CCIE Peer Mentorship Program, your main responsibilities include:
1. Be currently enrolled at Highline College with a GPA of 2.5 or higher.
2. Attend training sessions from November 2025.
3. Meet with your mentee 2-3 times monthly from February to June 2025.
4. Attend at least one CCIE or CLS event with your mentee or independently.
5. Join the End of Quarter Celebration for the CCIE Peer Mentorship Program.
Note: Accepted applicants will receive a $400 stipend over the 2024-2025 academic year. International students with an SSN are eligible to apply.

For more information, please visit our CCIE and CLS websites.
Acknowledgment*

I have read and agreed to all expectations.I have questions about some expectations.I do not agree to all expectations.

Contact Info & Next Steps
What questions do you have regarding the Peer Mentorship Program?*
In general, what is the best way to reach you?*

EmailPhoneTextOther
Let’s schedule a ‘Get to Know You’ meeting!*
Thank you for your interest in the CCIE Peer Mentorship Program!

If you have any questions about the application process, feel free to contact us at same@highline.edu or (206) 592-3901. We look forward to connecting with you soon!

Thank you for your interest in the CCIE Peer Mentorship Program!

Since this is your first quarter at Highline College, we encourage you to sign up to be a peer mentee instead. Peer Mentor role is only offered to students who completed more than one quarters at Highline College or other colleges.
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You are eligible to be a peer mentor!