* First Name

* Last Name

* Student ID

* Phone

* UHCL Email

Alternate Email

Degree Plan/Major

Date First Enrolled at UHCL (Semester, Year)

Estimated Graduation Date (Month, Year)

Extracurricular Activities (i.e., student organization involvement):

What skills will you bring to the position?

* Why do you want to be a Peer Mentor?
Please provide detailed information including your expectations from the program.

When your form is submitted successfully, you see a Thank You webpage. You can expect to receive an email from us within 3 to 5 days. If you don't hear back from us by then, contact mentors@uhcl.edu.

State law requires that you be informed of the following:
(1) with few exceptions, you are entitled on request to be informed about the information the University collects about you by use of this form;
(2) under sections 552.021 and 552.023 of the Government Code, you are entitled to receive and review the information; and
(3) under section 559.004 of the Government Code, you are entitled to have the University correct information about you that is incorrect.