Peer Mentor Request Form
This online request form is for students who are interested in working with a Peer Mentor or for campus staff and faculty who would like to refer students to work with a Peer Mentor from Peer Connections. More information about Peer Connections can be found online at:

The Role of a Peer Mentor
Peer Mentors are trained student leaders who are knowledgeable about the college experience –inside and outside of the classroom. They understand how challenging and overwhelming college life can be for students, especially during the first year. Peer Mentors are here to guide you through the college transition process and to assist you in developing the social and academic skills to succeed at San Jose State.

Work with a Peer Mentor to receive:
• Support and regular communication through meetings and emails
• Strategies for developing college success skills for academic and social settings
• Connections to important campus resources, tutoring, services, and events

To connect with a Peer Mentor, please complete this initial request form along with the Peer Connections Mentor Intro Form - Fall 2018:

Student Name *
e.g. Linh Tran
Your answer
Your answer
Email Address *
Your answer
Who referred you to Peer Connections?
Name of Referral Person
If you were referred by a faculty member, staff member, or an educational counselor, please list the name.
Your answer
Available days and times for a mentoring appointment:
Example: Mondays 12 - 2pm, Fridays 9 - 11am
Your answer
Comments or questions you may have for the Peer Mentor:
Your answer
Never submit passwords through Google Forms.
This form was created inside of SJSU. Report Abuse - Terms of Service