Peer Mentoring Program Application

Peer Mentoring Program Application

Reading Area Community College
Time

: Hour Minutes AM/PM Option
Name *

First Name Last Name
Student ID# *
Enter your full 7 digit student id#
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number
(555) 555-5555
RACC Email *
example@ravens.racc.edu or example@racc.edu
I am applying to be a *

Mentor (faculty/staff recommendation required) Mentee
NOTE: If you are applying to be a Mentor, please make sure that the Staff/Faculty Peer Mentor Recommendation form is also completed.
Major/Academic Program *
College credits earned to date *
GPA *
Gender *

Male Female

Days and times you are available to meet with your mentor/mentee *

Monday

Tuesday

Wednesday

Thursday

Friday

8:AM - Noon

Noon - 8:PM