Sensible Nutrition and Body Image Choices
Peer Educators (S.N.A.C.)
Application for Peer Educator Position
Please type or print in black ink
Name ________________________________ E-mail _____________________
College Address _____________________________________________________
__________________________________ Phone number ____________________
Permanent Address ___________________________________________________
__________________________________ Phone number ____________________
College Major __________________________ Current GPA ____________
Expected Date of Graduation __________________________________________
PERTINENT EMPLOYMENT AND SKILLS
| Name of Employer | Position | Dates of Employment | Identify any Transferable Skills |
|---|---|---|---|
STUDENT ORGANIZATION INVOLVEMENT
Indicate any student organizations you are in currently or will be involved in during the upcoming semesters.
| Organization | Office Held (if any) | Dates in Group |
|---|---|---|
STATEMENT OF INTEREST
Please respond to the following questions on a separate sheet of paper.
1. Why are you interested in becoming a member of S.N.A.C.?
2. What quality/skills will you bring to the group? What skills would you like to develop while in the group?
3. Have you or someone close to you been affected with any type of eating concern? If so, how will this affect you in your work as a peer educator?
4. List any time constraints that will affect your involvement in S.N.A.C. (school, job, volunteer activities, etc.)
5. Describe your level of interest, experience, and skills in each of these categories: promoting campus events, giving a presentation, designing an awareness event/project.
6. Please include any additional information about yourself that you feel is relevant to joining S.N.A.C.
REFERENCES
Each candidate must have at least one reference (preferably from an employer, academic advisor, or other adult who can give an objective overview). It is the applicant’s responsibility to ensure that the recommendation form is completed and returned to Room 268, Lafene Health Center.
Reference name, address, and telephone number:
_______________________________________________________________
Reference name, address, and telephone number:
_______________________________________________________________
Please Note:
This completed reference form should be returned by October 1st.
(If you have any questions, call 785.532.6595 or send an email
to snac@k-state.edu.)
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 _________________________________
January 2008