JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
N.C.I.V.S. Peer Mentoring Application 2015-16
Answer all questions honestly and concisely. Please complete all fields with an asterisk.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First and Last Name
*
Your answer
I am a
*
new peer mentor.
returning peer mentor.
I am in Grade
*
10
11
12 (returning to Northern next year)
My homeroom teacher is:
*
Your answer
My email address is:
*
Your answer
My phone number is:
*
Provide the number that is best to reach you.
Your answer
My parent/guardian is aware that I want to become involved in the peer mentoring program. My parent/guardian's name is:
*
Your answer
My parent/guardian can be reached at:
*
Please provide a phone number or email address.
Your answer
What 3 words would you use to describe yourself?
*
Your answer
What extracurricular activities are you involved in? What are your hobbies and interests?
*
Include any sport, club, or volunteer activities that can be school or community related.
Your answer
Why do you think you will be a great peer mentor?
*
Your answer
I understand that the peer mentoring program is a year-long program that will require me to miss some class time as well as be available for training/events outside of the school day.
*
Please check all boxes that apply.
Yes, I understand this.
My parent(s)/guardian(s) are aware of the commitment I am making.
Required
Please provide the name of the teacher or administrator who supports your application to become a peer mentor.
*
Your answer
All applicants will be interviewed. Select the best period(s) for your interview to be scheduled in.
*
Check all that apply.
Period A
Period B
Period C
Period D
Required
Your answer
Thank you for your time. There will be a mandatory meeting at lunch for all applicants next week. Please listen to announcements for the date and time.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Lambton Kent District School Board.
Report Abuse
Forms
