PEER EDUCATOR APPLICATION

Date of Application ___________________

Name _____________________________________                        Phone ________________________

E-mail _______________________

Campus/Local Address ____________________________________________________

Permanent Address _______________________________________________________

Permanent Phone ____________________

Major __________________                        Overall GPA _______________

Year in School ___________              Expected Graduation ________

PLEASE CHECK YOUR MAJOR INTEREST AREAS:          

____  Group facilitation/Presenting Programs

____  Publicity/Advertising

____  Program Planning/Development

Please respond to the following questions.  You may use extra paper if necessary.

1.      Why are you interested in becoming a peer educator?

2.      Please list and describe any relevant courses, training, work or volunteer experience, and programming experience which you think would contribute to your involvement as a Peer Educator.

3.      What personal strengths can you bring to this program?

4.      Being a Peer Educator does involve an on-going time and energy commitment (training, meetings, programs, etc.).  How do you think it will be for you to fit this program into your schedule?

5.      What do you think are currently the most pressing student concerns with respect to health/wellness and social issues?

Please return this form to:   Lee Smith

                                         Substance Abuse and Sexual Assault Educator

                                         P.O. Box 7008, Tyler Hall, Radford University

                                         Radford, VA 24142

                                         831-5709