Peer Mentor Application
Student Name *
Student Number (lunch number - starts with 1) *
Grade Next Year *
Parental signature: giving permission via a digital signature to participate in the Peer Mentor program upon selection. (Type name here) *
Student signature indicating they understand that this class will require that pictures and information regarding students not be shared with persons outside of the class. (Type name here.) *
Please list the teacher you would like contacted regarding your recommendation for this course. *
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