Sexual Health Awareness Peer Educators
S.H.A.P.E.

APPLICATION FOR PEER EDUCATION POSITION

PLEASE TYPE OR PRINT IN BLACK INK.

Name __________________________________ E-mail ________________________

College Address ________________________________________________________

Phone Number ________________________________________

Permanent Address _____________________________________________________

College Major ________________________ Current GPA _______________________

Year in School _______________ Expected Date of Graduation ___________________

HAVE YOU SEEN A S.H.A.P.E. PRESENTATION?  YES________  NO_________

Have you discussed this position with a current Peer Educator/S.H.A.P.E. member?

Yes______No______ If yes, Whom? ________________________________________

What do you believe are the major responsibilities of this position?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

STUDENT ORGANIZATION INVOLVEMENT

Indicate any student organizations you are currently or will be involved in during the upcoming semesters.

APPLICABLE EXPERIENCES

Indicate any information you may feel might be pertinent to this application (i.e., honors conferred, special skills or training, unusual qualifications, work experience or other volunteer work, etc.)

_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

I hereby certify that all statements and answers set forth on this application are complete and true.  I understand that false statements or omissions will cause the termination of my application.

Signature of Applicant __________________________________  Date_______________

By placing my initials here (__________), I DO NOT consent to have my photo used in marketing, educational andpromotional material, to include web site, display and printed brochures, produced for Lafene Health Center.

APPLICATION INFORMATION

The completed application form should be returned by ____________________________ to:

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Interview Information
References
Course and Program Information
Position Description

INTERVIEW INFORMATION

Upon receipt of your application, you will be contacted to schedule an interview conducted by a current SHAPE member(s) and the advisor.  Be prepared to discuss the questions and situational responses listed below.

1. Why are you interested in the Peer Educator position?
2. Describe past experiences, including leadership positions, that qualifies you for this position.
3. What leadership skills, if any, did you acquire from these experiences.
4. What are your strengths and weaknesses?
5. Describe a past situation, without disclosing names, when you had to keep information confidential.
6. Describe a situation when you had to be objective or nonjudgmental.
7. Describe a situation in which you were of significant help to someone.
    A. Why did you choose to help?
    B. Describe your helping actions and behaviors.
8. Describe a time when you were especially busy with multiple demands at one time.
    A. Identify two (2) major stressors for yourself at that time.
    B. Describe the strategies you utilized to respond to these stressors.

REFERENCES

After the completion of the interview, each candidate selected will be asked to provide two references: one campus reference (i.e., employer, advisor, faculty/staff, RA, Greek House officer, etc.) and one personal reference (someone who knows you  well, NOT a family member). 

The reference forms will be mailed to selected applicants with their acceptance letter.  Acceptance to the SHAPE Program is conditional as both campus and personal references must be received in the Health Promotion Office within 2 weeks of the date on the acceptance letter.

COURSE & PROGRAM INFORMATION

Applicants are required to participate in the SHAPE Program for 2 consecutive semesters. 3 credit hours will be earned at the completion of course requirements.  An “Incomplete” is placed on the transcript at the end of the first semester.  The letter grade is recorded for the first semester at the completion of the second semester. 

EDCEP 311 meets Tuesday/Thursday 2:30 PM - 3:45 PM. The 3 course credits can be applied toward leadership minor or as unrestricted elective credits.

Following completion of two semesters, SHAPE members are encouraged to participate in the program until graduation!

SHAPE is funded through Lafene Health Center.  For more info, e-mail shape@ksu.edu.

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Sexual Health Awareness Peer Educator

Position Description

POSITION PURPOSE: The Peer Educator serves as a liaison between fellow students and Lafene Health Center.  Each member is responsible for performing duties to fulfill the program mission:  to provide sexual health information and education to students at Kansas State University and in surrounding communities.  Upon the completion of the first semester, peer educators are fully prepared to carry out the following duties and responsibilities.

DUTIES AND RESPONSIBILITIES:

1. Will serve as a campus liaison and resource person for the Kansas State University and surrounding communities.
2. Will attend formal class sessions on a variety of topics including: Sexually Transmitted Diseases (including HIV), Sexual Health, Alcohol/Drug, Sexual Orientation and other related issues.  Will complete course requirements under the direction of the Health Promotion staff at Lafene Health Center
3. Will promote the S.H.A.P.E. program to the Kansas State University campus and surrounding communities through public relations efforts.
4. Will participate as a team member to present the Peer Program upon request.
5. Will serve as a positive role model to the Kansas State University campus and surrounding communities.
6. Will participate in other activities and promotions sponsored by Lafene Health Center.
7. Will disseminate and collect audience evaluations upon the conclusion of each Peer presentation and return these forms to the Health Promotion department.
8. Will complete Facilitator's program evaluation upon the conclusion of each Peer presentation and return the form to the Health Promotion department.
9. Will complete other job-related duties as required.  This will include assisting other individuals within the Health Promotion department when the need arises.

The above tasks will be subject to an ongoing evaluation by the Health Promotion staff.  Failure to adequately perform designated duties may result in the disruption of services and inappropriate representation of Lafene Health Center.

Criteria for Sexual Health Awareness Peer Educator

THE S.H.A.P.E. CANDIDATE MUST BE WILLING TO FULFILL AND FOLLOW THE FOLLOWING CRITERIA GUIDELINES

1. Must currently enroll as a full-time or part-time KSU student.
2. Must receive an overall average personal interview rating of 200 or greater.
3. Must be able to commit at least 2 consecutive semesters involvement.
4. Must demonstrate leadership skills.
5. Must demonstrate appropriate objectivity and open-mindedness.
6. Must demonstrate appropriate confrontation skills and conflict resolution skills.
7. Must demonstrate appropriate comfort when confronted with scrutiny.
8. Must demonstrate appropriate comfort with condom distribution and demonstration.
9. Must demonstrate effective time management skills.
10.  Must demonstrate effective communication skills.
11.  Must demonstrate effective interpersonal relationship skills.
12.  Must demonstrate ability to maintain strict confidentiality.
13.  Must demonstrate a personal interest and enthusiasm in becoming involved in the program.
14.  Must be willing to represent Lafene Health Center in a positive way.

(Revised 10/08)

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