First Name: 

Middle Initial: 

Last Name: 

Preferred First Name: 

Network Username: 
                                   (i.e. peik@mailbox.sc.edu - username=peik)

Last 4 digits of SSN: 

Preferred E-mail Address: 

Preferred Phone Number: 

Street: 

City: 

State: 

Zip Code: 

Street: 

City: 

State: 

Zip Code: 

Class standing for 2010-2011 based on cumulative credit hours: Please selectJunior (60-90 hrs)Senior (90+ hrs)

Cumulative GPA: 

Did you transfer to USC? Please selectYesNo

If yes, from what institution? 

Did you take University 101? Please selectYesNo

If yes, when?Please selectSpring 2005Fall 2005Spring 2006Fall 2006Spring 2007Fall 2007Spring 2008Fall 2008Spring 2009Fall 2009

Major 

1. Please list your major campus and community involvements. Include any awards you have received and any leadership positions you have held.
 

2. Please list all relevant work experiences (including internship, work study, part-time, summer jobs, etc.). 

3. What is your definition of a University 101 Peer Leader? Describe what you perceive to be the role of a peer leader and how you would perform such a role if you were selected. (250-500 words) 

4. Identify your personal and professional goals. How could serving as a peer leader assist you in reaching these goals? (250-500 words) 

5. Describe your personal attributes/ qualifications that would contribute to the success of first-year students and to the University 101 Peer Leader Program. (250-500 words) 

Please select your preferences for group interview times using the dropbox function. (Note: To provide for the most valuable experience, it is our recommendation that you do not sign up to interview with friends.) You will be notified of your group interview status via e-mail no later than 5:00pm Friday, January 29, 2010

Friday, February 5, 2010

8:00-10:00	Please select1234N/A
10:30-12:30	Please select1234N/A
2:00-4:00	Please select1234N/A
4:30-6:30	Please select1234N/A

Check here if studying abroad in Spring 2010 

***Those studying abroad spring 2010, will interview Thursday, December 3, 2009 2:00-4:00pm unless other accommodations are discussed with the University 101 staff.

Please provide the name and e-mail address of the person who will write a professional recommendation for your application. Please note: your application is not considered complete until we have received a recommendation for you and therefore you will not be eligible for selection as a Peer Leader.

Recommender Name:  

Recommender E-mail Address:

I acknowledge that the information in this application is factual and is a realistic assessment of my abilities. I recognize being a University 101 Peer Leader carries with it both privileges and responsibilities.

I hereby give permission to the University 101 office to obtain information from my University of South Carolina education records and the Office of Student Judicial Programs regarding any disciplinary records in my name as defined by the Family Educational Rights to Privacy Act (FERPA) for purpose of verification of position expectations and requirements. This information will be used for the sole purpose of determining my suitability for this position.

Full Name:           Date January February March April May June July August September October November December   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020    

The University 101 Program, within the University of South Carolina, provides affirmative action and equal opportunity in education and employment for all qualified persons regardless of race, color, religion, sex, national origin, age, disability, sexual orientation, or veteran status.