Faculty/Staff Referral Form

Please confirm th efollow: I have discussed thsi opportunity with the student. They consent to this recommedation and expct to be contacted by Peer Navigator Program.

Faculty/Staff Name

Faculty/Staff Email

How do you know the student you are referring?

Student Information

Student First Name

Student Last Name

Student ID#

Student SMC Email

Student Major

Recommendation Information

Why are you recommending this student for peer mentoring?

How would this student benefit from working with a Peer Navigator (check all that apply):

Additional comments regarding the needs of this student:

Please review the above information and verify that it is accurate.