Lock It Up Project

Peer Education Program Application

Peer Educator PEP Application Spring 2021

Please note: Peer Educators will be required to attend all trainings, end of semester events, and major Lock It Up Project events with prior notice. Peer Educators will also participate in select events, activities and projects which may take place virtually. Events you choose to participate in will require to pass fingerprinting clearance.

Please feel free to email Genesis Lopez at glopez@healthcollaborative.org if you have any questions.

Thank you!

(NOTE: All training’s will take place via Zoom. Meetings/training’s will occur twice a month.)

Monday, February 1, 2021 by 10:00 am

Tentatively set for February 2, 2021 – February 5, 2021 (Only on weekdays between 8:00 am-5:00 pm)

Saturday, February 6, 2021 from 9:00 am-11:00 am

Saturday, February 20, 2021 from 9:00 am-11:00 am

Saturday, March 6, 2021 from 9:00 am-11:00 am

Saturday, March 20, 2021 from 9:00 am-11:00 am

Saturday, April 10, 2021 from 9:00 am-11:00 am

Saturday, April 24, 2021 from 9:00 am-11:00 am

Saturday, May 8, 2021 from 9:00 am-11:00 am

Peer Education Program Spring 2021 Application

Name*
First Last
Birthday (mm/dd/yyyy)*
Gender*
Gender Prounouns*
School*
College Year*
Expected Year to Graduate*
Undergraduate or Graduate Degree*
Major*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Phone*
Preferred Method of Communication*
What is your availabilty?*
Please list specific times and days of the week you are available (ex. 2-5pm)
Are you able to commit a semester to the program?*
- Yes
- No
If you answered no, please explain why:
Are you able to travel?*
- Yes
- No
Are you able to work weekends?*
- Yes
- No
Can you attend every meeting listed above?*
- Yes
- No
If you answered no, please explain which events you cannot attend and why:
How did you hear about the Peer Education Program?*
Why are you interested in becoming a Peer Educator?*
What strengths do you feel you can bring to the Peer Education Program?*
What are ways that you would create more visibility and reach out to students and faculty on your college campus?*
Please list any personal development experiences (i.e. courses, trainings, etc.) that have contributed to your interest in and qualifications for this position:*
Please provide two references (non-family) below:*
Include Name, Title, Phone, and Email for each reference.
Please attach a copy of your resume to this application.*
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Lock It Up Project

Peer Education Program Application

Peer Education Program Spring 2021 Application

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