P2P Mentor Application

First Name

Middle Name

Last Name

Race/Ethnicity

Gender

Street Address

City

State

Zip/Postal Code

Home Phone

Mobile Phone

Email Address

What is your preferred method of communication?

Phone

Please select your current academic year

First-year

Second-Year

Third-Year

Fourth-Year +

Please describe what strengths you will bring to this program?

Min: 200 Words

Write a brief statement on why you have chosen to participate in Rider University’s P2P MENTORING Program for Undergraduate Students of Color

Min: 200 Words

Why do you want to become a mentor?

Min: 200 Words

What days of the week are you available?

Monday

Tuesday

Wednesday

Thursday

Friday

Check all that apply.

Please list specific times (with the respective days) that you are available

Reference 1

Reference 1 Name

Reference 1 Address

Reference 1 City

Reference 1 State

Reference 1 Zip/Postal Code

Reference 1 Phone Number

Reference 1 Relationship

Reference 2

Reference 2 Name

Reference 2 Address

Reference 2 City

Reference 2 State

Reference 2 Zip/Postal Code

Reference 2 Phone Number

Reference 2 Relationship

Reference 3

Reference 3 Name

Reference 3 Address

Reference 3 City

Reference 3 State

Reference 3 Zip/Postal Code

Reference 3 Phone Number

Reference 3 Relationship

Do you speak a foreign language? If so, please explain in detail.

Min: 200 Words

Please list any hobbies or interests you have?

Min: 200 Words

My favorite subject in college has been

Min: 200 Words

My least favorite subject in college has been

Min: 200 Words

What kind of activities would you like to enjoy with a mentee?

Min: 200 Words

What individual has served as a role model for you thus far? Why?

Min: 200 Words

What is your T-shirt size?

Disclaimer *
I understand that by applying to this position/program, I agree that the head of CDI may conduct a “student conduct background check” on my records while a student here at Rider University.

Further, I agree that, depending on the nature and severity of my student conduct history, I may be excluded from obtaining this position or being a part of this program.

I also agree that if I do obtain this position, or if I am accepted into this program, and at a later date, I receive an allegation of misconduct, I must seek to discuss the situation with the head of CDI immediately.

The nature and severity of that incident may be grounds for my dismissal from this position/program.

Agree

By checking this box, I certify to the best of my ability that the information provided here on the application is true and accurate and that I understand the above language on my conduct while at Rider.

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Next application submission Spring 2021

P2P Mentor Application