Peer Mentor Application Form Today's Date* MM slash DD slash YYYY Student InformationStudent Name* First Last Best Contact Number*UTK Email* Preferred PronounsMajor and Career Goals*What type of degree are you currently pursuing?* Bachelor's Master's Doctoral Non-Degree Seeking Are you a non-traditional student?A nontraditional student is a student who pursues postsecondary education at a later stage in life typically after a gap since their last experience with formal education. Yes No Unsure Is this your first time being an SDS peer mentor?* Yes No Please indicate the semesters you've served as a peer mentorPlease explain why you want to become a peer mentor for Student Disability Services.*What are your interests and hobbies?*Please list any campus groups or organizations in which you are involved?*What qualities do you possess that would help you be an effective peer mentor?*Hint: What strengths do you have that would make you a good mentor?Please describe your understanding of what will be expected of you as a peer mentor, both in time commitment and the ways in which you will assist students.*How do you think being a peer mentor will benefit you?*Please note any preferences you have in terms of the characteristics of mentees you may be assigned, (e.g. gender, disability, major, etc.).If we have more students to be mentored that we have mentors, would you be interested in mentoring more than one student? (There is no requirement that you do so.)* Yes No Please let us know how you prefer to meet with your mentee(s).*In-personVirtualI don't have a preferenceAre you interested in serving as a mentor in the Spring semester?*YesNoDo you need any accommodations when meeting with your mentee? If yes, please explain.I commit that I will: Commitment 1* Complete a required online, asynchronous peer mentor training and required in-person peer mentor training. Commitment 2* Meet with my mentee once per week for about an hour throughout the fall semester. * Attend at least one program or event with my mentee during the fall semester. * Report my initial meeting date, time, and location with my mentee to SDS. * Report the name, date, and time of the campus program or event that I attend with my mentee to SDS. * Report to SDS staff any issues or concerns throughout the mentoring relationship * Treat my mentee(s) with dignity and respect without regard to their race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. * I understand the information contained in my interest form may be shared with my mentee(s). I agree not to share or disclose any information related to my mentee with others, except as necessary with the SDS staff for purposes of managing the mentor/mentee relationship. EmailThis field is for validation purposes and should be left unchanged. Δ