College of Chemical and Life Sciences, University of Maryland

Peer Mentor Application - Due February 9, 2007 by 4:00 PM
Applicant Information

Name: ____________________________________Student I.D. Number: _________________

Address:_____________________________________________________________________

____________________________________________________________________________

Local phone number:(include area code) ______________________________

E-mail address: ________________________________

Major: _________________________________

Credits by end of Fall Semester:___________________ Grade Point Average: _____________

Campus Related Activities:_______________________________________________________

____________________________________________________________________________

 

 

 

 

 

 

 

 

 

Availability for Position

Projected year and date of graduation:______________________
 

Reference Information
(References will be contacted by phone.  Letters not required)

 
Reference: _____________________________ Reference:_____________________________ 
Phone #: _______________________________ Phone #: ______________________________
Email:__________________________________ Email:_________________________________

 

Return the following to 1300 Symons Hall, College of Chemical and Life Sciences:

Signature of applicant:______________________________ Date: ________________________