PMP - Peer Mentor Intent Form

The fields that have an * beside them, are required before submitting this form.

* Last Name:

* First Name:

* Email:

* Phone:

* Current Local Address:

* Do you plan to remain a mentor for the upcoming school year?

	Yes (please complete remainder of the form)
	No

If not, please indicate why:

	I will be graduating this spring/summer
	My schedule will be very demanding and I cannot commit time
	My experience did not meet my expectation
	Other

Thank you for your service as a Peer Mentor during this academic year.

Complete this section only if returning for upcoming year.

Summer Address:
Alternate email address:

If you will be in the Raleigh area this summer, will you be available to assist with Peer Mentor planning for next year?

	Yes
	No

Last Updated: August 17, 2008