Middle Earth Peer Assistance Program Application

Contact Information
Your Pronouns*
Your Expected Graduation Date*
Please include the semester and the year. For example, Spring 2025 or Fall 2027.
Your Phone Number*
Please enter a valid phone number.
Your UAlbany Email Address*
example@albany.edu

Interest in the Middle Earth Peer Assistance Program
Which Middle Earth Peer Assistance Program position(s) are you interested in?*

Hotline AssistantPeer Wellness Ambassador
Why do you want to join Middle Earth? (100 words maximum)*

0/100
Your Name*

First NameLast Name
In your own words, please describe what a "helping relationship" means to you. (100 words maximum)*

0/100

Background
Applicants who answer “yes” to any of the questions below will not be automatically disqualified. Applicants’ histories and experiences are considered on a case-by-case basis.
Have you ever been placed on academic probation while in college?*

YesNo
Please explain why you were placed on academic probation and how the situation was resolved.*
Have you ever been suspended or expelled from college?*

YesNo
Please explain why you were suspended or expelled and how the situation was resolved.*
Have you ever been referred to Community Standards at UAlbany or a similar office at another college/university?*

YesNo
Please explain why you were referred and how the situation was resolved.*
Have you ever been fired from a job?*

YesNo
Please explain why you were fired and what you learned from the experience.*

Reference
Please list one University at Albany employee who can speak to your character (such as a professor, advisor, EOP counselor, etc.).
Reference's Name*

First NameLast Name
Reference's UAlbany Job Title*
Reference's UAlbany Department, Office or Unit*
Reference's Phone Number*
Please enter a valid phone number.
Reference's UAlbany Email Address*
example@albany.edu

Acknowledgement
The information I have provided in this application is accurate to the best of my knowledge. Furthermore, I understand that any position offered to me by the Middle Earth Peer Assistance Program is on a semester-to-semester basis and my continued participation will be determined based on an evaluation of my Middle Earth participation and my academic and judicial standing. I hereby authorize the Middle Earth Director to verify my student status, academic performance and judicial standing and to randomly check collateral sources, such as social networking sites, for additional information as needed.*

I acknowledge and agree to the above statement.
By clicking the “Submit” button, I consent to be contacted via email.
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