Peer Mentee Application

First Name:

Last Name:

Student Number:

Utoronto Email Address:

Telephone:

Alternative Email:

Current Program of Study:

Year of Study:

Country of Origin:

First Language:

Gender Pronoun:

(She/her’s/hers’s, he/him/his, they/them/theirs, or other)

Check all that apply:

First Generation Student

International Student

Indigenous Student

Student Athlete

Familiar with Accessible Learning Services

How did you hear about the PSP Program?

What interested you about this program? What inspired you to seek mentorship?

Do you currently have any wellness goals? (e.g., better sleep, coping with exam anxiety, building confidence, increasing physical activity)

Please list any special interests or hobbies:

When are you generally available for 1:1 mentor meetings?

Are you currently experiencing any mental health issues?

Yes

I authorize the PSP Program Facilitator to share my U of T email address with the Peer Mentor I am matched with.

Yes

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HCC’s Peers Supporting Peers Program (PSP) @ UTM