USC Peer Mediation Program Application

Please submit all applications and resumes by 5:00PM on January 30th, 2009 via e-mail to
mediate@usc.edu.

NAME________________________________________________________________
__________

Class Standing:
__ Freshman
__ Sophomore E-mail Address __________________________________
__ Junior
__ Senior Major __________________________________
__ Graduate Student

Local Address (Please provide residence Permanent Address

hall & room number if you live on campus.)
___________________________________ ____________________________________
___________________________________ ____________________________________

Local Phone # (____)__________________ Permanent Phone # (____)_______________

Ethnic Background (optional)__________________________________________________________

Experience
Briefly list your membership or leadership commitments at USC for this academic year (Please also
attach a resume):
Organization Position/Duties Hours/Days of Week
_________________________________ ___________________________ _________________
_________________________________ ___________________________ _________________
_________________________________ ___________________________ _________________

Essays – Please attach ONE sheet of paper with your responses to questions 1-3.
1) Please explain why you are interested in the mediation training and becoming a peer mediator
for Student Judicial Affairs and Community Standards.
2) What unique skills and experiences will you bring to your role as a peer mediator?
3) How do you see yourself applying the mediation training in your life and for the USC
community?
4) Please list all of the times you are available to interview (between 10am-8pm) on the
following days:
Monday, Feb 2nd _______________________________
Tuesday, Feb 3rd _______________________________
Wednesday, Feb 4th _______________________________
Thursday, Feb 5th _______________________________
Agreement
I acknowledge that admission to this program is based on an application and interview process,
and all of the information I have provided for this process is accurate and written by me. I also
agree that if I am accepted as a member of this organization, I will pay the standard membership
dues that support this organization.
Signature__________________________________ Date _______________
For more information, please see our website at http://www.usc.edu/student-affairs/SJACS/mediation.html
If you any questions, please contact: mediate@usc.edu
Student Judicial Affairs and Community Standards
A Division of Student Affairs