Access Us Peer Mentor Request Form

"*" indicates required fields

Name: *

First Last

Preferred name:

Pronouns:

Email: *

Phone:

Are you comfortable with us providing your mentor with your phone number?

Yes

Who is your accessibility advisor? *

What year of studies will you be starting in September? *

If you are registering later in the academic year, what year of studies are you in now?

What college or faculty are you part of? *

What is your program of study? *

I would like to work with a peer mentor because I am hoping to... *

My biggest worry for this year is... *

Do you have any preference for your mentor? E.g. gender, age, whether they have a disability or not. Please describe: *

Describe your comfort level working with people from other cultural backgrounds than your own: *

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