Fillable TAP Peer Mentor App 2018-2019x - peermentorapp2018-2019

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TAP Peer Mentor App 2018-2019x - peermentorapp2018-2019

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2018-2019 Peer Mentor Application
The Project TAP Peer Mentoring Program is a year-long mentoring commitment
designed to assist first-year students on the Autism Spectrum.
APPLICANT INFORMATION
Last Name First Name Date:
Address Mailbox #
City State Zip
Home Phone Cell Phone
Email @mail.harpercollege.edu
Harper ID#
H00
GPA
Available all of 2017-2018? Yes☐ No☐ If No, please explain
Co-curricular activities, athletic teams and employment responsibilities for 2017-2018:
REFERENCE 1 (PROFESSIONAL/ACADEMIC OR WORK-RELATED)
Full Name Relationship
Organization Phone ( )
Address City State Zip
Email @
REFERENCE 2 (PROFESSIONAL/ACADEMIC OR WORK-RELATED)
Full Name Relationship
Organization Phone ( )
Address City State Zip
Email @
MISCELLANEOUS
Other relevant experience:
Besides English, other spoken languages?
SUPPLEMENTAL QUESTIONS
Why are you interested in becoming a peer mentor?
If selected, what skills would you bring to the position?
What are your personal and academic interests?
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
Signature Date
Return your completed Peer Mentor Application to Project TAP
Email: projecttap@harpercollege.edu
Fax: 847.925.6267
Mail: Project TAP / ADS
Harper College
1200 W. Algonquin Road
Palatine, IL 60067-7398
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TAP Peer Mentor App 2018-2019x - peermentorapp2018-2019

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Completed 19 May 2020

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