Volunteer Peer Health Educator Application

Please fill out this application and return it to either the Thagard Health Promotion office on the 4th floor, or to the patient survey box located on the first floor next to the elevators at Thagard Student Health Center.
Last Name:
First Name:
Email Address:
Local Phone:
Cell Phone:
Local Address:

1. Describe briefly what you hope to get out of becoming a peer educator.

2. Describe any past experience you may have in peer education. (not required)

3. Describe any personal experiences or qualities of your personality which you feel would be
beneficial to the role of a peer health educator.

4. How did you hear about being a peer educator?

5. Which peer education program(s) are you interested in applying for?

FSU (For Sexual Understanding) Today
KARMA (Knowing About Responsible Management of Alcohol and other drugs)
STRIKE (Students Tobacco Reform Initiative Knowledge for Eternity)
SUNN (Students For Understanding Nutrition Now)
THE LOC (Total Health Empowerment for Ladies of Color)
RENEW (Realizing Everyone’s Need for Emotional Wellness)
BBTHM (Building Block for the Total Health of Men)

6. These peer education programs may ask for 2-3 hours of your time a week. How many hours a
week could you realistically devote to peer education?