L.E.A.P. Peer Mentee Application

PLEASE NOTE: Some of these questions may be personal, however, they are only asked to ENHANCE your experience as a potential Mentee with the LEAP Peer Mentoring Program.

Name Name * First Last
LAST 4 digits of your SS# *
E#
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone # Home Phone # * - ### - ### ####
Cell Phone # Cell Phone # * - ### - ### ####
Which Campus Residence Hall will you be living in? If you don't know yet, put "I don't know yet"! *
What High School OR Community College did you attend? *
Ethnicity *

Ethnicity White (Non-Hispanic) Black (Non-Hispanic) Latino/Hispanic Asian or Pacific Islander American Indian or Alaskan Native Bi-Racial
Gender Identity *

Gender Identity Male Female Non-binary Transgender
Personal Email *
EIU Email (If you know it)
Intended College Major *
Birthday Birthday * / MM / DD YYYY
How would you or your friends describe you? *
What do you like to do for fun? *
What types of organizations are you involved in or interested in joining? *
What would you like to know about Eastern? *
Are there specific characteristics you would want us to consider in matching you with a L.E.A.P. Peer Mentor? *
What do you hope to gain from this peer mentoring experience?
Have you an ATTENDED virtual or in-person Freshmen Orientation? *

Have you an ATTENDED virtual or in-person Freshmen Orientation? Yes No
Have you completed your FAFSA yet? *

Have you completed your FAFSA yet? Yes No