PROJECT SHAPE: SEXUAL HEALTH AND PEER EDUCATION APPLICATION FOR VOLUNTEER POSITION Name: ___________________________________ Local Mailing Address: ______________________ _________________________________________ _________________________________________ Permanent Address: ________________________ _________________________________________ _________________________________________ Major: _________________ Class Year: ________ Student I.D. Number ________________________ Phone Number: ____________________________ E-mail Address: _______________________
Please explain why you are interested in becoming a sexual health peer educator. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
What do you hope to gain as a volunteer for Project SHAPE? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
What types of work and/or life experiences have you had that would help you in your work with Project SHAPE? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Briefly describe your beliefs about the role of a peer educator. ___________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Generally, what kinds of interests and/or commitments do you have, other than school? (e.g. hobbies, extra-curricular activities, etc.) _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Do you have any particular interest or projects that you would like to pursue under the auspices of Project SHAPE? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
Additional Comments (if additional space is necessary, please attach a separate sheet of paper): _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
REFERENCES: Please provide us with the names, addresses, and telephone numbers of two individuals who know you. At least one of these references should be from a faculty or staff member. 1. __________________________________________________________________________
2.
__________________________________________________________________________
YOUR SCHEDULE Please fill in the following schedule with the times you are generally NOT available each day between 9:00 AM and 10:00 PM. This will help us when setting up interviews.
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Please return this completed application to: Carol P. Stenger, M.Ed. & M.A. Director, Project SHAPE 400 Patroon Creek Blvd., Suite 104 Albany, New York 12206
