Peer Mentoring Application

Personal Information

Name:______________________________________________ A#:______________________

Address:______________________________________________________________________

Preferred Email:___________________________________ Cell Phone:__________________

Cumulative GPA:__________________________________ Credits Earned:______________

Major(s):_________________________________________

Do you belong to any campus organizations or VU sports teams?                   Yes        No
If so, please list them:
1.	________________________________________________________________________
2.	________________________________________________________________________
3.	________________________________________________________________________

Essay
Write on one of the following (150-250 words, double-space):
●	What is your idea of a leader and how can you lead other students who are beginning their college career?
●	What is the value of team-building and how can you support other students who share the goal of college success?
Disciplinary Check
You must have a disciplinary check in order to work with our students. By signing below, you are authorizing us to perform the disciplinary check with the Office of Judicial Affairs.

I, _______________________________, hereby authorize Vincennes University personnel in the Division of Student Affairs to disclose personal, identifiable information, specifically regarding past or present disciplinary action against me. This authorization will remain in effect from the date it is executed until revoked by me, in writing, and delivered to the Division of Student Affairs.

Signature:_______________________________________ 			Date:________________________