APPLICATION FORM FOR NEW PEER LEADERS
Peer Leader’s Job Description:

1) Is interviewed: Dec. 4 at 4:30pm, or Dec. 11 at 1:00pm (one hour); contact Prof. Janet Liou-Mark at JLiou-Mark@citytech.cuny.edu
2) Conducts Workshop sessions as scheduled (more information will be provided during the interview).
3) Registers for MEDU 2901: Peer Leader Training in Mathematics (Meets January 22, 2013 from 9AM-1 PM for Orientation, followed by one-hour weekly class sessions on Fridays, 8:30-9:45 AM); one-credit course.
4) Attends weekly Leadership Seminar (Tuesdays from 1-2 PM).
5) Informally evaluates the progress of individual group members.
6) Maintains a database of attendance and survey results for workshop participants.
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Full Name *
e.g. John Smith
Today's Date *
e.g. DD/MM/YYYY
Address (Street) *
e.g. 300 Jay Street
Address (City) *
e.g. Brooklyn
Address (State) *
e.g. New York
Home Phone *
e.g. 555-555-5555
Cell Phone *
e.g. 555-555-5555
E-mail *
Major *
e.g. Applied Mathematics
What course(s) are you interested in leading workshops? *
e.g. MAT 1175, MAT 1275, MAT 1375, etc.
Who is recommending you for the position? *
e.g. Professor John Smith
Recommendations E-mail *
Last four digits Social Security # *
e.g. 1234
Credits Completed *
e.g. 75
GPA *
e.g. 3.00
Are you a US citizen? *
If no, are you eligible to work?
Clear selection
Have you ever had experience as a workshop leader or as a tutor? *
Why do you want to be a workshop leader? *
MAT 1175: Fundamentals of Mathematics - Grade *
MAT 1175: Fundamentals of Mathematics - Semester *
e.g. Fall 2012 or Not Applicable
MAT 1275: Intro to Mathematical Analysis - Grade *
MAT 1275: Intro to Mathematical Analysis - Semester *
e.g. Fall 2012  or Not Applicable
MAT 1375: Pre-Calculus - Grade *
MAT 1375: Pre-Calculus - Semester *
e.g. Fall 2012 or Not Applicable
MAT 1475: Calculus I - Grade *
MAT 1475: Calculus I - Semester *
e.g. Fall 2012 or Not Applicable
MAT 1575: Calculus II - Grade *
MAT 1575: Calculus II - Semester *
e.g. Fall 2012 or Not Applicable
MAT 2675: Calculus III - Grade *
MAT 2675: Calculus III - Semester *
e.g. Fall 2012 or Not Applicable
MAT 2580: Linear Algebra - Grade *
MAT 2580: Linear Algebra - Semester *
e.g. Fall 2012 or Not Applicable
MAT 2680: Differential Equations - Grade *
MAT 2680: Differential Equations - Semester *
e.g. Fall 2012 or Not Applicable
BIO 1101: Biology I - Grade *
BIO 1101: Biology I - Semester *
e.g. Fall 2012 or Not Applicable
BIO 1201: Biology II - Grade *
BIO 1201: Biology II - Semester *
e.g. Fall 2012 or Not Applicable
BIO 2311: Human Anatomy and Physiology I - Grade *
BIO 2311: Human Anatomy and Physiology I - Semester *
e.g. Fall 2012 or Not Applicable
BIO 2312:Human Anatomy and Physiology II - Grade *
BIO 2312:Human Anatomy and Physiology II - Semester *
e.g. Fall 2012 or Not Applicable
PHYS 1433: Physics 1.2 - Grade *
PHYS 1433: Physics 1.2 - Semester *
e.g. Fall 2012 or Not Applicable
PHYS 1434: Physics 2.2 - Grade *
PHYS 1434: Physics 2.2 - Semester *
e.g. Fall 2012 or Not Applicable
PHYS 1441: Physics 1.3 - Grade *
PHYS 1441: Physics 1.3 - Semester *
e.g. Fall 2012 or Not Applicable
PHYS 1442: Physics 2.3 - Grade *
PHYS 1442: Physics 2.3 - Semester *
e.g. Fall 2012 or Not Applicable
PHYS 2443: Physics 3.3 - Grade *
PHYS 2443: Physics 3.3 - Semester *
e.g. Fall 2012 or Not Applicable
CHEM 1110: General Chemistry I - Grade *
CHEM 1110: General Chemistry I - Semester *
e.g. Fall 2012 or Not Applicable
CHEM 1210: General Chemistry II - Grade *
CHEM 1210: General Chemistry II - Semester *
e.g. Fall 2012 or Not Applicable
CHEM 2223: Organic Chemistry I - Grade *
CHEM 2223: Organic Chemistry I - Semester *
e.g. Fall 2012 or Not Applicable
CHEM 2323: Organic Chemistry II - Grade *
CHEM 2323: Organic Chemistry II - Semester *
e.g. Fall 2012 or Not Applicable
Name of other relevant course # 1
e.g. MAT 2672: Probability and Statistics I
Other relevant course # 1 - Grade
Clear selection
Other relevant course # 1 - Semester
e.g. Fall 2012 or Not Applicable
Name of other relevant course # 2
e.g. MAT 2672: Probability and Statistics I
Other relevant course # 2 - Grade
Clear selection
Other relevant course # 2 - Semester
e.g. Fall 2012 or Not Applicable
Name of other relevant course # 3
e.g. MAT 2672: Probability and Statistics I
Other relevant course # 3 - Grade
Clear selection
Other relevant course # 3 - Semester
e.g. Fall 2012 or Not Applicable
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