PHA Volunteer Application

Important notice: Please note that this form will be submitted through an unsecured line. If you do not wish to submit your application via an unsecured line, you can pick up a physical copy of the application in Room 310 at the Student Health Services. Just bring the completed form back to Room 338.

Please feel free to contact Stacey Edwards at 541-737-7555 if you have any further questions.

Date: *

Name: *

E-mail: *

Local Phone: *

Local Address: *

Permanent Address: *

Class Standing: *

Major: *

Date of Graduation: *

What is it about Peer Health Advocates that has interested you in volunteering for the organization?: *

Please list and describe any personal qualities, courses or experiences that would contribute to your involvement as a volunteer: *

What do you expect to gain from the experience of volunteering as a Peer Health Advocate?: *

Are there any topics that you are not comfortable with? If so, why?: *

Please list one professional reference (faculty/staff/professional) and include name, phone number and e-mail address: *

Please list one personal reference (student) and include name, phone number and e-mail address: *

Are you willing and able to commit to volunteering at least two (2) hours per week for each term?: *

Yes

The Peer Helper Skills training course (H349) is required for new volunteers. Are you able to take the course prior to or during your first term of volunteering?: *

Yes

How did you find out about the volunteer opportunities at Student Health Services?: *

If other, please explain:

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