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College of DuPage Office of Student Life Student Leadership Retreat Leadership Mentor Application Form Monday, August 1st

t to Tuesday, August 2nd, 2011 George Williams College, Lake Geneva, Wisconsin
Please complete this application to be a Leadership Mentor at the Student Leadership Retreat. Leadership Mentors will assist Student Life staff in facilitating retreat activities and will mentor small groups of students while at the retreat and possibly into the academic year. To be eligible for a Leadership Mentor position you must be: enthusiastic and outgoing, comfortable working in teams, a current C.O.D. student (minimum 2.0 GPA) returning for fall 2011 and you must have participated in the Student Leadership Retreat previously. Participation in the Living Leadership Program preferred but not required. Students must be available to attend the entire retreat Mon. 9 a.m. to Tues. 8 p.m. Applications are due by Thursday, July 14th to Student Life (SRC 1800) or by e-mail to studentlife@cod.edu. General Information Full Name: C.O.D. Club Affiliation (if any): E-mail (we will use this to communicate with you): Mailing Address: Home Phone: Please mark one: Birth Date:
(for enrollment verification)

Cell Phone: Male Female

Housing and Meal Information Please list any special accommodations you may need:

Roommate Request (all attendees will have roommates):

Meals are included. Please list any special food needs or allergies you may have:

Short Application Questions: What is your personal leadership philosophy?

What are 3 things you would like to share with incoming students about COD?

PLEASE TURN THIS PAGE OVER AND SIGN

By signing and submitting this form, I agree: 1. to abide by College of DuPage policies and procedures. 2. to pay up to $150 of the cost of the retreat if I do not meet my mentoring obligations at the retreat. 3. I am a College of DuPage student with a 2.0 GPA or above and will be taking classes fall 2011. Signature: _____________________________________________________ Date: ____________________________________

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