Skidmore College: applicationform

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Peer Health Educator Application:

Personal Information

Name:

Campus or Local Address:

Email Address:

Phone Number:

College Experience

Academic Class:

Expected date of graduation:

GPA last semester:

Cumulative GPA:

Are you in good academic and social standing?:

Yes

If no, please explain:

Leadership Experience/Activities

Please list Skidmore activities/organizations with which you have been involved/volunteer experience, etc (including any offices held).:

Please list any honors or awards received. Please include approximate dates.:

Activities: What other activities, internships, on- or off-campus jobs, etc. do you are plan to contribute to next year?:

Do you plan to go abroad next year?:

Yes (Fall 2010)

Yes (Spring 2011)

Reflection Questions

Please tell us your motivation in becoming a Peer Health Educator.:

What prior training, experience, or knowledge do you have regarding health and wellness topics? Please note: These are not a prerequisite for applying to be a PHE.:

Describe any other experiences (extra-curricular, volunteer, leadership, etc) which are relevant to you becoming a Peer Health Educator.:

Describe some of your personal strengths and explain how you see them benefiting this group.:

Please provide the name and contact information (phone and/or email address) or one person (not related to you) who can speak to your qualifications.:

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