Peer Undergrads Program Application
Welcome and thank you for applying to be part of the UMSL Social Peers Program! Please fill out the survey below and submit when you are finished. Just a few notes:
1. This semester-long program begins in February 2021 and ends in May 2021.
2. To be part of the program, you must commit to participate in weekly meet-ups (virtually or physically distant) with your UMSL Succeed peer for at least 30 minutes.
3. To be part of the program, you must commit to participate in weekly check-ins with a peer undergrad coordinator in order to discuss your meet-up and support for you to be a successful peer undergrad.
Thank you again and let us know if you have any questions!
Dr. Lindsay Athamanah,
What is your name?
What is your gender?
Prefer not to say
What is your current age?
What is your race/ethnicity?
American Indian or Alaska Native
Asian or Asian American
Black or African American
Hispanic or Latinx
Native Hawaiian or Other Pacific Islander
White or Caucasian
Mixed or Multiple Ethnicities
What is your current year in school?
Freshman (less than 28 earned credits)
Sophomore (28 - 55 earned credits)
Junior (56-87 earned credits)
Senior (88+ earned credits)
What is your current or intended major?
Which college do you belong to?
Arts & Science
Pierre Laclede Honors College
UMSL/Wash U Engineering Program
Fine & Performing Arts
What is your current grade point average (GPA)?
3.00 - 3.49
2.00 - 2.99
1.00 - 1.99
Are you currently employed?
Yes, I am full-time employed (>30 hours/week)
Yes, I am part-time employed (<30 hours/week)
No, I am unemployed.
What is your living arrangement?
Living at home with family members
Living in a residential hall
Living in a sorority or fraternity house
Living in an off-campus apartment/house with roommates
Living alone in an off-campus apartment/house
Have you had any experience interacting with a person who has a disability? (Check all that apply)
I am a person with a disability.
I have a family member with a disability.
I have a friend with a disability.
I have a classmate with a disability.
I have volunteered for people with disabilities.
I have met a person with a disability at a public event.
What are your current interests, hobbies, extracurricular activities?
What is your spring semester schedule and availability?
What are your personal reasons for participating in this social peer program?
Will you commit to participate for the entire spring semester (February to May) in the UMSL Social Peers Program?
Will you commit to meeting with your UMSL Succeed peer weekly either online or in person while physically distant (e.g., going on a walk outside) for 30 minutes?
Will you commit to meeting with a peer undergrad coordinator to discuss your weekly meet-ups and support for you to be successful?
Is there anything else we would need to know or keep in mind for you to be successful as a part of this program?
By filling out this form and submitting it, you confirm you are enrolling into our social peers program and understand the time commitment and expectations that we have outlined. Please type your initials below to indicate you have read through and understand this form and you agree to be a part of our social peers program:
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