PEER Mentee Application

ASIAN PACIFIC AMERICAN PEER PROGRAM
University of Southern California
Asian Pacific American Student Services
Student Counseling Services
PEER MENTEE APPLICATION

APA PEER (Positive Experiences, Enriching Relationships) program is a university student service program conducted by APASS and the Student Counseling Services. It is designed to help new undergraduate freshman and first-year transfer students adjust to college life. Continuing students act as mentors who are eager to share their experiences and provide advice for incoming students. Mentors are also trained on issues that affect the Asian Pacific American student. These issues include identity, race relations, and campus life. The relationship between mentors and mentees is one-on-one and confidential.

Name (Last, First, MI):

Social Security #:

Birthday:

Ethnic Background:

Gender:

Major(s) or Program:

Minor(s):

Class:

Local Address:

Local Phone Number:

Other #s to contact:
(Pager, Mobile)

Permanent Address:

Permanent Phone Number:

Email Address:

Mentees must be interviewed before they can be matched with mentors. Interviews run between 20-25 minutes. Please indicate at least three days (including time blocks) that you will be available for an interview during the three weeks beginning October 5th.
1.
2.
3.

You may also download and print out this form and return it to:
APASS, Student Union 410, Los Angeles, CA 90089-4851 or FAX to (213)740-5284.
For more information, contact Jonathan Winarko at (213)740-4999 or email at jonwinarko@hotmail.com.

Name (Last, First, MI):
Social Security #:
Birthday:
Ethnic Background:
Gender:
Major(s) or Program:
Minor(s):
Class:
Local Address:
Local Phone Number:
Other #s to contact: (Pager, Mobile)
Permanent Address:
Permanent Phone Number:
Email Address:
Mentees must be interviewed before they can be matched with mentors. Interviews run between 20-25 minutes. Please indicate at least three days (including time blocks) that you will be available for an interview during the three weeks beginning October 5th. 1. 2. 3.