Official Stanford Neurodiversity Project Peer Mentor Application
Thank you for your interest in becoming a Peer Mentor!  

Please find a description of the Stanford Neurodiversity Project Peer Mentor role and commitment at:
https://med.stanford.edu/neurodiversity/student-support--im-.html

Please complete this application form by 11:59 pm on October 13, 2019.  

Interviews will be held via Zoom and/or in person between Oct. 14-25th
Notification of acceptance as a peer mentor will be sent on Oct. 25th.

If accepted as a Peer Mentor, you will need to:

Complete a fingerprint/background check anytime before the start of winter quarter.
Attend an orientation once during fall quarter; we will arrange a time that works for everyone.
Complete a total of five 1-hour trainings during fall quarter.

First Name *
Last Name *
email *
phone number *
address *
Will you be living on campus or off campus 2019-2020? *
Why are you interested in becoming a peer mentor? *
What experience do you have with Neurodiversity? *
What is your vision for supporting students who are Neurodiverse at Stanford during their college years? *
What are your interests and hobbies (academically, personally, socially/community, athletically/actively?) *
What are some of your strengths? *
What are some of your challenges? *
What goals do you have for personal growth? *
How comfortable are you with planning and completing multi-step projects? *
not at all comfortable
very comfortable
How comfortable are you with public speaking or speaking in front of groups? *
not at all comfortable
very comfortable
How comfortable are you with being around others who might exhibit "unexpected behaviors" (e.g. speaking loudly in public, standing too close or too far when speaking in person, missing common social cues such as turn taking in conversation, etc.) ? *
not at all comfortable
very comfortable
How comfortable are you with modeling social skills for others? *
not at all comfortable
very comfortable
How comfortable are you with advocating for yourself and others (e.g. clearing up miscommunications, dealing with subtle or overt bullying or discrimination)? *
not at all comfortable
very comfortable
How comfortable are you with engaging in non-preferred activities (e.g. when your peer wants to pursue their special interests which may be uninteresting to you)? *
not at all comfortable
very comfortable
How comfortable are you with attending regularly scheduled meetings or gatherings? *
not at all comfortable
very comfortable
How comfortable are you with responding to texts or emails from a student mentee on a regular basis within 24 hours? *
not at all comfortable
very comfortable
Check boxes to confirm availability:  I could attend peer mentor orientation during fall quarter. Note: we will work with mentors to schedule a time that works for everyone. *
Required
Check boxes to confirm availability:  I am available for weekly 1-hour trainings during fall quarter. Note: we will work with mentors to schedule a time that works for everyone. *
Required
Please send a copy of your resume or other documentation outlining your experience to stanfordneurodiversityproject@stanford.edu
Please provide the contact information of at least two references Reference 1:  Name, phone number, email, relationship (e.g. friend, supervisor, teacher, etc.) *
Reference 2:  Name, phone number, email, relationship (e.g. friend, supervisor, teacher, etc.) *
Please add any other comments relevant to your interest in becoming a Stanford Neurodiversity Project (SNP) Neurodiverse Student Support Program (NSSP) Peer Mentor.
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