Peer Mentor Form :: Dakota College at Bottineau

First Name *

Last Name *

DCB Student ID *

Date of Birth (DOB) *

Cellphone *

Email *

Confirm Email *

How did you hear about our program? *

What is your academic major? *

What year are you? *

Freshman

Sophomore

Are you already employed on campus? *

Yes

If so, where?

Are you eligible for work study? *

Yes

I'm not sure

How many hours a week would you like to work? (Typically you must be available to work for a minimum of 4 hours a week in order to be a mentor) *

Do you have a license to operate a motor vehicle? *

Yes

Are you willing to drive our students if needed? (ASPIRE reimburses for gas mileage) *

Yes

I'm not sure

What area are you MOST interested in providing support for our students in? Please check all that apply. *

Employment / Job Coaching

Academics / In Classroom & Study Time

Independent Living Skills

Social Events