MENTOR APPLICATION
PROGRAM INFORMATION:
The S4S Peer Mentor Program provides campus wide services aimed to increase the
engagement, connectedness, and retention of students at SAC through the support of peer mentors.
Peer Mentors serve as role models to SAC students by helping them access resources and navigate the
college setting. Upon selection, peer mentors will assist students through one of the following
programs: Assessment Center, the Santa Ana College Promise (previously Adelante Program),
Counseling, First Year Connect, Guardian Scholars, or Admissions/Library IQ Bars.
BENEFITS:
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Paid on-campus position.
iPad-loan for Spring & Fall semesters.
Earn 3 transferrable units by taking Counseling 125 “Exploring Leadership” in Fall 2017.
Earn 1 unit and learn effective study skills by taking Study Skills 091 in Spring 2018.
Joining a community of Student Leaders.
Opportunities for personal & professional growth through peer-interactions, trainings & workshops.
Exposure to networking opportunities.
Collaboration with other SAC programs. .
REQUIREMENTS:
SAC student taking at least 6 units in Fall & Spring.
Have a minimum of 12 units completed by Fall 2017.
Maintain 2.5 minimum overall GPA.
Must commit to participate for 2 semesters (Fall & Spring).
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Participate 10 or 15 hours per week in the program.
Take 3-unit Counseling 125 “Exploring Leadership” class during Fall 2017 on Wednesdays from
3:00pm to 6:10pm & Study Skills 091 “Effective Study Techniques” (1 unit) in Spring 2018, time TBD.
• Attend Peer Mentor Orientation the first week of August and participate in all monthly meetings held
the first Friday of each month from 1:00-3:00pm.
• Submit Application in L-223 before June 16, 2017.
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Please turn in your complete application in the Assessment Center (L-223) by June 16th, 2017. If you
meet the requirements listed above, you will be invited to participate in an interview. If accepted into
the program, you will be expected to attend a mandatory program orientation the first week of August
(time/date to be determined). At the orientation, you will be notified of your assignment.
For program details or application visit: www.sac.edu/S4SPeerMentoring
or contact: Maria Camarena in the SAC Assessment Center (L-223)
(714) 564-6152
[email protected]
IS YOUR APPLICATION COMPLETE?
Before turning in your application please make sure you have all
the documents listed below:
Application check-list:
□ Copy of unofficial transcripts
□ Resume
□ Confidential Recommendation form (included in application)
□ Brief response to the following questions (1 page total on a separate sheet of paper)
1) What qualities/strengths would you bring to the S4S Peer Mentor Program?
2) How would you help students succeed at SAC?
3) What are your career goals?
□ Weekly Time Finder (included in application)
□ Students 4 Students (S4S) Questionnaire (included in application)
Students 4 Students (S4S) Peer Mentor Application
Date:
Name:
Date of Birth:
Gender (Circle One): Female / Male
Social Security # or Tax Payer I.D #:
Address:
City / State:
Cell Phone:
Residency (circle one):
Student Number:
Zip Code:
Home Phone:
AB540
Current or Former Foster Youth?
Yes / No
E-Mail:
Permanent Resident
Are you a current Veteran? Yes / No
Are you First Generation College Student?
Yes / No
US Citizen
F1 Visa
Are you part of the Disable Student Program (DSPS)?
Ethnicity (e.g., Latino, Asian…):
Yes / No
List your hobbies/interest:
Have you worked through Student Placement/Work Study at SAC? Yes: _____ No:_____ If yes, When? __________ Where? ________
Are you a current or former Rancho Santiago District (SAC or SCC) employee? Yes: ____ No: ____ If yes, When? _________________
**NOTE: If you become employed by RSCCD at any time during the program, please let the staff know as soon as possible.
Major:
Expected Graduation Term/Yr:
Career Goal:
Do you work? Yes / No
If Yes, How many Hours?
Financial Information:
Family Annual Income for 2015:
Number of family members: ____
$_____________
Are you eligible for financial assistance (FAFSA, Fee Waiver, EOPS, etc…)?
Yes
Independent /
/
Dependent
No
In order to be considered for S4S, please submit the following materials with the application
□ Copy of unofficial transcripts
□ Resume
□ Confidential Recommendation form (included in application)
□ Briefly respond to the following questions (1 page total on a separate sheet of paper)
1) What qualities/strengths would you bring to the Students 4 Students (S4S) Peer Mentor Program?
2) How would you help students succeed at SAC?
3) What are your career goals?
□ Weekly Time Finder (included in application)
□ Students 4 Students (S4S) Questionnaire (included in application)
I certify that the above information is correct and understand that I may be asked to provide supporting documentation including tax returns.
Signature: ________________________________________________
Date: ____________
FOR OFFICE USE ONLY:
Application Complete:
Pending documents:
Rec. Letter:
G.P.A :
Units:
Residency:
Accepted:
Additional Notes:
Orientation:
Program:
Students 4 Students (S4S) Peer Mentor Program
Weekly Time Finder
Please fill in your class and work schedule and other weekly commitments you may have, as
well as what time(s)/date(s) you might be able to meet with your Mentees.
Name: ________________________________
Student Number: _______________
Please rate your 3 top program choices ( 1 to 3, with 1 being your top choice) in which you
feel you would be the most helpful to mentees. Please note that assignments are based on
programs' need, and placement in one of your 3 top choices is not guaranteed.
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Admissions / IQ Bar
Assessment Center
Counseling
Guardian Scholars / YESS Program
First Year Connect
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Santa Ana College "Adelante" Promise
List specific skills that you have, and make you the ideal candidate to be a Peer Mentor in
any of the above programs:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
STUDENTS 4 STUDENTS (S4S) PEER MENTOR QUESTIONNAIRE
Name: ________________________________________________
Please rate how you feel about the following statements. Important: Answer what best fits
you. There are not right or wrong responses.
Statement
I am able to manage my time wisely
I am able to stay on task and maintain my
focus at all times
I am confident about my organization skills
I am able to network with others
I tend to be quiet and keep to myself in
public/group settings
I tend to start conversations and interact with
others in public/group settings
I prefer taking leadership positions
I make time to goof around, laugh ,and have
light-hearted fun
Patience is important to me
I am open minded and expect others to be as
well
My personal and/or academic strengths are:
My personal and/or academic challenges are:
Strongly
Agree
Agree
Neutral
Disagree
Strongly
Disagree
Students 4 Students (S4S)Peer Mentor Confidential Recommendation Form
Provide this form to someone who is familiar with your qualifications. Once completed, have your recommender seal it in an
envelope and sign across the flap.
___________________________________________ is applying to be a mentor to Santa Ana College Students. Please provide us with your
Applicant’s name
assessment of this applicant’s potential for this position.
Recommender’s Name:
Title:
How long have you known the applicant?
In what capacity have you known the applicant?
Category
Rate the Applicant (circle one)
Comments
1-Poor, 2-Below average, 3-Average, 4- Above average, 5- Excellent
Professional competence (responsible,
punctual etc.)
1 2 3 4 5
Not Observed
Ability to conceptualize, organize, and
communicate ideas:
1 2 3 4 5
Not Observed
Ability to establish / maintain
relationships with others:
1 2 3 4 5
Not Observed
Awareness and sensitivity to first
generation, low income transfer
students:
1 2 3 4 5
Leadership Skills:
1
1
1
1
Resourcefulness:
Communication Skills:
Initiative:
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
Not Observed
Not Observed
Not Observed
Not Observed
Not Observed
Additional comments/concerns:
Overall Recommendation (check one):
o I highly recommend the applicant
o I recommend the applicant
o I recommend the applicant with some reservation. For the following reason(s):
_____________________________________________________________________________________________
o I do not recommend the applicant
Signature: __________________________________________________________ Date: ________________________
Contact Number: _______________________________________
E-Mail: _______________________________________