Peer Undergrads Program Application

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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, athamanahl@umsl.edu

Email *

What is your name? *

What is your gender?

Female

Male

Prefer not to say

Other:

Clear selection

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

Other:

Clear selection

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)

Clear selection

What is your current or intended major?

Which college do you belong to?

Arts & Science

Business Administration

Education

Nursing

Optometry

Pierre Laclede Honors College

UMSL/Wash U Engineering Program

Fine & Performing Arts

Social Work

Non-degree seeking

Other:

Clear selection

What is your current grade point average (GPA)?

>3.50

3.00 - 3.49

2.00 - 2.99

1.00 - 1.99

<1.00

Clear selection

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.

Other:

Clear selection

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

Other:

Clear selection

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.

Other:

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?

Yes

Clear selection

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?

Yes

Clear selection

Will you commit to meeting with a peer undergrad coordinator to discuss your weekly meet-ups and support for you to be successful?

Yes

Clear selection

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:

Submit

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