Name:                      Semester:                      Date:
Local Address:                      Student ID
E-Mail Address:                     Telephone No.                      Program:
1) Explain your reasons for applying to be a peer mentor:
2) List your skills, abilities and experiences and how they relate to mentoring:
3) Why is it important for a first year student to have a good role model and mentor?
4) What personal qualities do you possess that will enable you to be an effective mentor?
5) Please provide the name, position, department and phone number of two (2) references: (i.e. current or former employer, church, coach, instructor) (Your application must include one (1) recommendation letter from a person listed below)
6) List any FSU Recognized Student Organization in which you hold a position. (i.e. President, Secretary, Committee Chair)
7) How did you become aware of the SCHOLAR Peer Mentor Program?	Personal Letter        FSU Student        FSU Faculty/Staff        Word of Mouth        Campus Advertisements (MyFSU, Torch, Posters, etc.)      Other
8) How many mentees would you be able to mentor?	(1)        (2)        (3)
9) What are your past roles in a mentor program?	Peer Mentor        Mentee        None