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ROCKET-2-ROCKET PEER MENTORSHIP PROGRAM

Peer Mentor Commitment Form

INSTRUCTIONS: Please provide information and answer questions as requested. Be sure to read and agree to the Peer Mentor commitments by checking the appropriate boxes at the bottom of the form. Questions about the peer mentorship program should be directed to either Michele Martinez (ext. 5323) or Jeff Witt (ext. 3701).

Name:

Rocket #:

Status for Fall 2009:

Major:

Anticipated Graduation Date:

Home Town:

E-mail Address:

Top 4 Areas of Co-Curricular Involvement :

Phone Number:

Local Mailing Address:

Summer 2009 Phone # (if different from above):

Summer 2009 Mailing Address (if different from above):

Referring Leadership Development Program:

Program Administrator Name & Title:

Program Administrator Email:

Program Administrator Phone Number:

PLEASE READ AND AGREE TO THE FOLLOWING PEER MENTOR COMMITMENTS BY CHECKING THE BOXES BELOW (scroll over [?] for further information):

Attend the Aug.17 R2R Training Program [?]

Attend the R2R Kick-Off Party [?]

Notify R2R Staff of Any Changes in Contact Information[?]

Serve as a Peer Mentor to 1-3 First-Year Students [?]

Communicate Weekly with Student Mentees [?]

Communicate Monthly with Faculty/Staff Mentor [?]

Join/Check R2R Peer Mentorship Facebook Account [?]

Keep an On-Line Journal of Mentee Connections [?]

Accompany Mentees to 3 UT Programs/Activities [?]

Attend the R2R End-of-Year Recognition Ceremony [?]

Consent to GPA Verification[?]

Please be sure you have filled out the form completely and accurately before submitting.

Page updated: April 22, 2009

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