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Academic Support Center
Austin Peay State University
Marks Building, Room 122
P.O. Box 4396
Clarksville, TN 37044
(931) 221-6553
academicsupportctr@apsu.edu

Home » Academic Support Center » Academic Partners Preparing for Success (APPS) - Mentor Application

Academic Partners Preparing for Success (APPS) - Mentor Application

Contact Information

Last Name: *

First Name: *

ID (A) Number: *

Phone Number: *

Format: (xxx) xxx-xxxx

Local Address: *

City: *

State: *

Zip Code:

email address: *

Permanent Address:

(If different from address above)

City:

State:

Zip Code:

Demographics

Gender: *

Major: *

Class: *

What is your current GPA?: *

Age Range: *

Are you a first generation college student:

Yes

No

Are you a Distance Learner (enrolled in only online courses): *

Do you have children?:

Yes

No

Are you a single parent?:

Yes

No

Military Service:

Employment:

Where do you live?:

What types of extracurricular activities are you involved in on campus?:

Select two groups of students you would be most interested in working with?: *

Traditional Students

Non-Traditional Students

Single Parents

Military/ Veterans

First Generation

On-campus residents

International

Online Learners

Other...

Which of these concerns have you struggled with and overcome to be a successful student? : *

Time Management Issues

Study Skills/Test Taking Skills

Balancing family life with school life

Attending College with a Disability

Getting involved in campus activities

Academic Difficulties

Financial Difficulties

Generation Gap (Over 21 Years of Age)

No Experience with Online Classes

Child Care Issues

Other...

Check all that apply.

Who should we contact in case of an emergency?

Name: *

Address: *

City: *

State: *

Zip Code:

Home Phone Number: *

Format: (xxx) xxx-xxxx

Alternate Phone Number:

Format: (xxx) xxx-xxxx

Emergency contacts email address: *

Austin Peay State University | Addresses | Clarksville, TN 37044 | 1-877-861-APSU | (931) 221-7011
Comments? | Emergency Notification

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