ASIAN PACIFIC AMERICAN PEER PROGRAM

University of Southern California
Asian Pacific American Student Services
Student Counseling Services

PEER MENTOR APPLICATION

The program format consists of an all-day introductory/training session on Saturday, Sept. 22, 2 mid-week 3 hour-long training sessions, and a one-day session as a conclusion of the training later on in the school year. The sessions will introduce topics and issues through exercises, videos, and discussion. Mentors who have completed their training will be matched with mentees later in the semester and be expected to continue the relationship throughout the Spring semester.

Name (Last, First, MI):
Social Security #:
Birthday:	Month January Febuary March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987
Ethnic Background:
Gender:	Gender Male Female
Major(s) or Program:
Minor(s):
Class:	Class Freshman Transfer
Local Address:
Local Phone Number:
Other #s to contact: (Pager, Mobile)
Permanent Address:
Permanent Phone Number:
Email Address:
Interview times (circle three): Interviews for new mentors will be held between Monday, Sept. 10 and Friday, Sept. 21. Please indicate your top three preferences for interview times out of the following time slots: Monday: 1-1:30, 1:30-2, 2-2:20, 2:30-3, 3-3:30, 3:30-4, 4-4:30pm Tuesday: 3-3:30, 3:30-4, 4-4:30, 4:30-5, 5-5:30, 5:30-6pm Wednesday: 1-1:30, 1:30-2, 5-5:30, 5:30-6pm Thursday: 4-4:30, 4:30-5, 5-5:30, 5:30-6pm Friday: 2-2:30, 2:30-3, 3-3:30, 3:30-4pm If you cannot make any of these times, please contact Jonathan Winarko to schedule an alternate interview time. 1. 2. 3.

You may also 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.