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OMD Peer Mentoring Services Mentee Application
UA students can submit this form to request a Peer Mentor.
Date of Birth (mm/dd/yyyy):
Primary Phone Number (555-555-5555):
UA Email Address:
I am a:
Select the option that best reflects your academic status based on accumulated credit hours.
Intended major (list 'undeclared' if undecided):
Interests and Mentor Options
Activities that I enjoy, or am interested in (please select all that apply)
I would like my Peer Mentor to be:
I have no preference
Based on your availability, indicate as precisely as possible the best days for your advising/mentoring meetings to take place:
OMD is open Monday-Friday, 8am-5pm
Best times for mentoring meetings
Please indicate your best times on each day that you selected in the previous question. If you do not know your upcoming semester's schedule, state so.
An asterisk (
) denotes a required field