Select a Peer Education Program ACT (Advocates for Cultural Talk) Blues Project (Suicide and Depression Prevention) DATE (Discovering Alternatives for Today's Encounters) JADE (Joint Advocates for Disordered Eating)

Name:        Student ID:   

E-mail

Phone Numbers:

Home:     Cell:

Home Address

Street:  City:  Zip Code:

Major:

Second Major:

Minor:

Class:   Select a Class Freshman Sophomore Junior Senior Graduate   GPA:   

Please answer the following questions to your best ability.

1. Why do you want to be a Peer Educator?

2. What do you hope to get out of this experience?

3. What do you bring to the Peer Education Program?

4. Describe your skills/capabilities or other experiences?