Peer Mentor Application Form Today's Date * Required MM slash DD slash YYYY Student InformationStudent Name * Required First Last Best Contact Number * RequiredUTK Email * Required Enter Email Confirm Email Major * Required Preferred Pronouns Is this your first time being an SDS peer mentor? * Required 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. * RequiredWhat 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? * RequiredPlease 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. * RequiredHow do you think being a peer mentor will benefit you? * RequiredPlease 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.) * Required Yes No Please let us know how you prefer to meet with your mentee(s). * RequiredIn-personVirtualI don't have a preferenceAre you interested in serving as a mentor in the Spring semester? * RequiredYesNoDo you need any accommodations when meeting with your mentee? If yes, please explain.I commit that I will: Commitment 1 * Required Complete a required online, asynchronous peer mentor training in the summer. Commitment 2 * Required Meet with my mentee once per week for about an hour throughout the fall semester. * Required Attend at least one program or event with my mentee during the fall semester. * Required Report my initial meeting date, time, and location with my mentee to SDS. * Required Report the name, date, and time of the campus program or event that I attend with my mentee to SDS. * Required Report to SDS staff any issues or concerns throughout the mentoring relationship * Required Treat my mentee(s) with dignity and respect without regard to their race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. * Required 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. PhoneThis field is for validation purposes and should be left unchanged. Δ