Nuturing Initiative & Achievement (NIA) Mentor Program

"It Takes a Villiage to Raise a Child" - African Proverb

Online Peer Mentor Application

Minority Student Services
Buffalo State College
Campbell Student Union, Suite 400
(716) 878-4631


Directions: Please fill out this form completely to ensure the best possible match. Thank you.
Name: Email Address: Date of Birth:
Local Address: Local Phone:
Permanent Address: Permanent Phone:

Do you have access to a computer?

Yes No  

Are you a transfer student? Yes No If you are a transfer student, from what school did you transfer?

 

Did you receive an Associates Degree?

Yes No    

What is your current status?

Freshman Sophomore Junior

Senior

Please answer the following by checking only one of the corresponding answers:
What is your mentee preference? No preference Male Female
Do you prefer to mentor a student who is: Traditional Non-Traditional No preference
How many hours a week can you mentor? 1-2 3-5 5-7 7-10
What is your current Grade Point Average? 3.5-4.0 3.0-3.5 2.5-3.0 2.0-2.5 Below 2.0
What is your status? Full-time Student Part-time Student      

Please list any clubs and/or organizations you are involved in:

Please list any additional languages spoken:
Please answer the following questions as thoroughly as possible. The more elaborate you are, the easier it will be to find a good match. Thank you.
Why do you want to be a Peer Mentor?
What are your career goals?
What are your personal goals?
What would you like your Mentee to get out of mentoring?
Please list your interests and hobbies:

 

If you have any comments, concerns or questions, please contact us at the Minority Student Services office, suite 400 of the Campbell Student Union, (716) 878-4631. If you are experiencing technical difficulties with this form or would like one mailed to you, please email us.

March 2004

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