Mentee Application – Peer Mentoring Student numberDate Name First Last ProgramEmail Alternate email PhoneAge range17-2021-2425-2930-3940+First languageOther spoken languagesDo you identify with any of the following? International Aboriginal First generation Questionnaire1. I prefer to be matched a peer mentor who is:MaleFemaleNo preference2. I prefer to be matched a peer mentor who is:A traditionally aged studentA mature studentNo preference3. I prefer to be matched a peer mentor who is:Quiet/a bit reservedOutgoingNo preference4. What is your reason for seeking a mentor? (select all that apply) Help with transition into college life Learn about different academic and service areas Help balance your school-work/home-life Have general questions answered Get updated on events, workshops and clubs Meet new people Other Please explain the "Other" reason for seeking a mentor.5. Check all elements you would like to see in your mentor Same academic program Same linguistic/cultural background Active on campus and/or in the community Other Please list the "Other" elements you would like to see in your mentor.6. Please provide any additional information you would like us to have:Which campus are you applying for?BarrieMidlandMuskokaOrilliaOrangevilleOwen SoundSouth Georgian BayPlease note:Any information you provide on this form will not be shared with any other party. By completing this form, you are agreeing to meet with your Peer Mentor once a week. By submitting this form you acknowledge the release of your name, phone number and e-mail address to your assigned mentor.Notice of collection of personal informationGeorgian College is compliant with the Freedom of Information and Protection of Privacy Act (FIPPA), 1990, and endeavors to treat your personal information in accordance with this law. The personal information requested on this form is collected under the legal authority of the Ontario Colleges of Applied Arts and Technology Act, 2002 and in accordance with Sections 38(2) and 41(1) of FIPPA. The information provided will not be used for any purposes other than to match students with Peer Mentors and facilitate contact between mentee and mentor. For further information about the information requested on this form or the purpose for which it will be used, please contact the First Year Experience and Transition Officer, 705.728.1968, ext. 1920 or email@example.com. For more information about FIPPA or your privacy, please contact the Access and Privacy Office at 705.728.1968, ext. 5770 or firstname.lastname@example.org.