RENEW: Realizing Everyone’s Need for Emotional Wellness
Peer Educator Program
The University Counseling Center

Membership Application

Applicant Information

Full Name:  __________________________DOB: _______________________
Local Address:                                               Permanent Address:
_________________________                      _____________________________
_________________________                      _____________________________
Phone (   )________________                       Cell Phone (   )_________________
Email ___________________
Major ________________     Year_______________          GPA__________

Please answer the following questions:
1.  What interests you about being a member of RENEW?

2.  What skills and qualities do you possess that would contribute to RENEW?

3.  What personal characteristics or attributes do you possess that would benefit RENEW?

4.  Do you have any experience with peer education or providing presentations? If so, describe your experience.

5.  Are you involved in any other organizations on campus? If so, which one(s)?

6.  Are you an officer in any other organization on campus? If so, which one(s) and what does the office require in terms of duties and time commitments?

7.  What benefits do you hope/anticipate to receive as a member of RENEW?
8.  Is there anything else you would like to add?

Please provide times you are AVAILABLE for RENEW activities in the spring.  Once you are trained as a presentation/workshop facilitator, the times provided below will be used to schedule you for presentations/workshops. 

I have read and agree to adhere to each of the member requirements listed in this application (see RENEW Member Requirement documentation)

  _________________________________________________                    ____________
Applicant Signature (or type name for electronic submission)                             Date