BRC Peer Guidance Program Application Form

The Black Resource Center Peer Guidance Program targets incoming first year Black/African American students (first time freshmen and transfer students) and pair them with current students who will serve as Peer Mentors. The BRC Peer Guidance Program is designed to address the needs of incoming students, ensure students are aware of and utilizing university resources, facilitate students’ transition to the university and retain students until degree attainment. As a part of this program it is expected that you meet in person with your peer mentor for an hour at least twice per quarter.

1General Information > 2Matching You With a Peer Guidance Leader
First Name *
Last Name *
Preferred Name
Email Address *
Phone Number Phone Number * - ### - ### ####
Hometown *
Major *
Minor
PID Number

If you do not know what this number is, ignore this question.
Gender Identity *

Gender Identity Gender Variant/Non-conforming Transgender Female Transgender Male Female Male Prefer Not to Answer Other Other
How would you describe your ethnicity?

(The fact or state of belonging to a social group that has a common national or cultural tradition.)
*
How would you describe your nationality?

(The status of belonging to a particular nation.)
*
How would you describe your race?

The term race refers to the concept of dividing people into populations or groups on the basis of various sets of physical characteristics (which usually result from genetic ancestry).
*
College *

College Revelle Muir Marshall ERC Warren Sixth Seventh
Current Status *

Current Status First-Year Incoming Student First-Year Transfer Student
Are you a first-generation college student?

Are you a first-generation college student? Yes No Unsure
Are you currently participating, or have participated in any of the following transition programs? (Check all that apply)

Are you currently participating, or have participated in any of the following transition programs? (Check all that apply) OASIS Summer Bridge JSOE Freshmen Summer Engineering Institute TRIO SSSP Chancellor's Associate Scholars Program (CASP) Triton Community Leadership Institute (TCLI) Student Success Coaching Program