Peer mentor request form

Info for NAU parents

Find out more about what Peer Jacks mentoring can do for your students. If you have any questions, comments, or concerns please feel free to contact us via email at PeerJacks@nau.edu or call us 928-523-6641.

Peer Jacks Mentor request form

Who are you? * Required
- I am a current/future student
- I am a parent/guardian/other
Student's First Name * Required
Student's Last Name * Required
Name
First Last
Home Address * Required
City State
NAU ID Number * Required
School Email * Required
Student's Cell Phone Number * Required
Message and data rates may apply. Minimum 2 text messages per month. Peer Jacks Mentors may utilize text messaging to schedule and confirm appointments as needed.
Major/Area of Study * Required
Minor(s)
Other/Special Considerations
Parents/Guardians/Other: By clicking here, I hereby confirm that I am completing this form on behalf of another individual and that the information provided is that of the current or future NAU student and not my own. * Required
- I agree
Students: By clicking here, I hereby confirm that all above information is mine, true, and correct to the best of my knowledge. * Required
- I agree

Peer mentor request form

Info for NAU parents

Peer Jacks Mentor request form

Peer Jacks Mentoring Program

Location

Mailing Address

Email

Phone

Peer mentor request form

Info for NAU parents

Peer Jacks Mentor request form

Peer Jacks Mentoring Program

Location

Mailing Address

Email

Phone

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