宅男研究所

L.E.A.P. Peer Mentor Application

Name Name First Last
E#
Birthday Birthday / MM / DD YYYY
Local Address Local Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone - ### - ### ####
Permanent Address (If different from Local Address) Permanent Address (If different from Local Address)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
宅男研究所 Email
What High School and/or Community College Did You Attend?
Current semester GPA (You can find this on PAWS)
Current Cumulative GPA (You can find this on PAWS)
Major
Minor
Year In School

Year In School Sophomore Junior Senior
Expected Graduation Date Expected Graduation Date / MM / DD YYYY
List your extra-curricular activities and/or organization memberships. (If none, put NONE)
What do you like to do for fun on campus
Are you willing to participate in an online training in April?

Are you willing to participate in an online training in April? Yes No
Will you be committed to meeting (email, text, FaceTime, etc) with your mentee AT LEAST 2 HOURS A WEEK?

Will you be committed to meeting (email, text, FaceTime, etc) with your mentee AT LEAST 2 HOURS A WEEK? Yes No
Will you have another work position (on OR off-campus) in during the fall semester?

Will you have another work position (on OR off-campus) in during the fall semester? Yes No
If YES, where will you be employed?
T-shirt size

T-shirt size Small Medium Large XL XXL XXXL
Essay: Imagine that it is your freshman year once again. Please tell me in 250 WORDS "What advice would you give to YOUR younger self?" NO ESSAYS UNDER 250 WORDS WILL BE READ!!! Please be mindful of grammar, typos, etc.
Must be between 250 and 400 words. Currently Entered: 0 words.
Or attach your essay

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