NSID: (eg. abc123)

Phone number:

Address:

Summer address (if different from above):

Summer Phone number (if different from above):

College:

Major:

Minor:

Current year:

Are you a full-time student?

• Yes
• No

Why are you interested in volunteering?

In your opinion, what are the greatest health concerns of university students?

Peer Health Educators work in small groups based on subject areas (see below). Please identify which groups you would prefer to join in order of preference (1–4).

• Mental Health
• Sexual Health
• Drugs and Alcohol
• Nutrition and Fitness

Please note these areas are interrelated and we encourage the groups to work together.

Many Peer Health Educator activities occur between 10am and 2pm on week days. How likely is it that you would be available on 1 or 2 weekdays during this time?

• Very likely
• Likely
• Not likely

It is expected that Peer Health Educator Peer Health Educators volunteer a minimum of 3 hours each week, including SHIP meetings. Will this work with your schedule?

• Very likely
• Likely
• Not likely

Are you employed elsewhere?

• Yes
• No

If yes, how many hours a week?

Do you have prior volunteer experience? If so where and what did the role involve?

What talents or experiences would you bring to the Peer Health Educator program? (i.e. artistic, public speaking, drama, computer skills, etc.)

Please use the space below to tell us any other information or experience that you have that would influence volunteering with Peer Health Educator.

Please provide one personal reference (no relatives please).

Name:

Title:

Relationship:

Phone number:

E-mail: