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Counseling Center and Health Center

Wellness and Self Care Peer Education Application

Please complete this application and click the "Submit Form" button to forward it to the Counseling Center and Health Center. If you have any questions, please contact Courtney Becker at (410) 704-2065.

Contact Information for Peer Education Application:

First Name:
Last Name:
Middle Initial:
E-Mail:
Cell Phone:
Local Phone:
Local Address:
City, State, Zip:
Home Phone:
TU ID#:
Date of Birth:

 

Current Standing:

Freshman
Sophomore
Junior
Senior

Major:
Expected Graduation Date:

1. Why are you interested in becoming a wellness and self care peer educator?

2. Please list and describe any relevant courses, training, volunteer and/or work experience.

3. Please list any campus/community organizations in which you are involved.

4. What do you think are the most important qualities and skills that a wellness and self care peer educator should possess?

5. What do you hope to gain from your experiences as a wellness and self care peer educator?

6. How did you hear about the wellness and self care peer education program?

I hereby, declare that all of the information provided on this application form is true to the best of my knowledge.

Online Signature (Typing your name is equivalent to an online signature.)

Date:


 

 

 

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