Peer Health Advocates Volunteer Application

Important notice: Once you click on the Submit button, you will automatically be taken back to the SHS homepage, indicating that your application has been successfully submitted. 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. You can also choose to print a copy for yourself by clicking here. Just bring the completed form back to room 338.

Please feel free to contact Stacey Edwards at 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 special qualities you possess, relevant courses, training, or past experiences (personal or volunteer experience) which 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 personal references: (1) faculty/staff/professional and (1) personal reference/student: (for both include name, phone number and email address)

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

Yes No

The Peer Helper Skills training course (H349) is recommended for new volunteers. Are you able to take the course?

Yes No

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

Barometer
Classroom
Flyers
Friends
Other: