WesWELL Non-Credit Class Withdrawal Form

Peer Health Advocate Application

Please complete this application form to be considered for a Peer Health Advocate position with WesWELL.

   
Full Name
Preferred Nickname, if any
Class Year
Email
Phone
Major(s) or Anticipated Major(s)
Are you currently in good academic and non-academic standing?      
 
Why do you wish to be a Peer Health Advocate?


 
What, if any, experience do you have in health education, peer education, or peer leadership?


 
What other organizations, clubs, or activities are you currently involved in? (include paid and volunteer activities)


 
What health issue(s) are you most interested in addressing as a PHA? (check all that apply)





 Other (please include below):


 
Do you possess any other skills or talents that you could utilize or express as a PHA?
(i.e. art,  public speaking, leadership, creativity, web page design, video production, etc.)


 
   
PHA Participation Guidelines

Peer Health Advocate volunteers are expected to:

  • Attend and actively participate in the required initial training weekend (January)
  • Attend and actively participate in any optional trainings offered, as interest and time allows
  • Attend a majority of the weekly planning meetings, currently held at 3:00pm on Sundays
  • Develop, participate in, and promote collaborative educational projects throughout the academic year
  • Maintain regular communication with your fellow PHAs, particularly the Team Leaders
By checking this box, I acknowledge that being a Peer Health Advocate involves fulfilling the above participation guidelines. I have a desire to perform the role of PHA as described above. I am capable of adhering to these guidelines, and have the time necessary to do so without over-committing myself and, as a consequence, compromising my academic, social, emotional, or physical well-being.

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revised 09/10/2009