Peer Health Educator Application

Fill out this application if you are interested in making a commitment to be an active peer health educator.

First Name
Last Name
Address Line 1
City
State
Zip
Phone
E-mail address
What is your GPA?
What is your class level?
(freshman, sophmore, junior, senior, grad)
When can you participate?
Following the completion of PHE Training, will you be able to make a commitment to be an active participant during: (please enter Fall or Spring)
Experience
List any health experience or course work relevant to health/wellness education you may have completed.

Student Organizations and Activities
List any prior student organization involvement:

Volunteer Experience
List any prior volunteer experience:

Leadership Experience
List any proir leadership experience you have had: