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.
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 and promotional material, to include web site, display and printed brochures, produced for Lafene Health Center.
The completed application form should be returned by ____________________________
Lafene Health Center, Room 268
1105 Sunset Avenue
Manhattan, KS 66502
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.
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 for the first semester (ONLY) and is recorded at the completion of the second semester.
EDCEP 312 meets Tuesday/Thursday 2:30 PM - 3:45 PM. New classes begin each semester and are worth three university general education (UGE) or K-State 8 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 email@example.com.
Sexual Health Awareness Peer Educator
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:
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