* Last name:
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* First name:
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* Undergraduate Program
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* Graduate Program
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* Credit Hours Earned:
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* Year first attended GSU:
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| Other colleges/universities attended: |
| 1 |
From/To
Degree(s)/Credits Earned |
| 2 |
From/To
Degree(s)/Credits Earned |
| 3 |
From/To
Degree(s)/Credits Earned
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* Address:
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* City:
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* State:
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* Zip or postal code:
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* Country:
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Home phone:
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Business phone:
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Cell phone:
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* E-mail address:
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* Best way to communicate (select all that apply):
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If you selected "Phone" above, best time to call (select all that apply):
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Describe any relevant experience you have in mentoring, tutoring, or working with students.
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Describe any skills you have which will help you be a good mentor.
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Why do you want to serve as a mentor?
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In what academic areas/subjects are you most interested?
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What are your hobbies?
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How many hours per week can you dedicate to mentorship without interfering with your other responsibilities?
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I attest that all information contained in this application is accurate to the best of my knowledge. I also agree that, if selected, I will abide by the requirements and responsibilities of the Peer Mentor Program.
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