On-Line Application form

Peer Health Education Application Form

The Health Promotion Program is designed to facilitate the development and maintenance of healthy lifestyles in University of Oregon students. To meet this goal, a variety of services are available including: group presentations, lending library in the Peer Health Promotion Office in the Health Center and Wellness Wednesday publications in the Emerald. The Peer Health Education program is a core component of the Health Promotion Program. The Peer Health Education Program requires a two term commitment (Pass/No Pass 4 credit hrs/term). The program includes classes designed to develop knowledge of current health issues, public health issues, behavior change principles, as well as presentation skills. The class meets every Tuesday and Thursday 10:00-11:50. Must be at least a sophomore to apply!

Application Procedure:
Interested students should complete and submit the following application form (with reference contact information). An interview is necessary for entrance into the program. The prerequisites are enthusiasm, ability to work in groups, accept supervisory feedback and a strong interest in working with your peers for the enhancement of healthy lifestyles!

First Name: Last Name:

Email: Local Phone #:

Cell # Student #:

Best time to reach you:
Morning
Afternoon
Evening

Year in School:
Sophomore
Junior
Senior

Term you wish to enter program:
Fall
Winter
Spring

Please explain briefly why you want to be a Peer Health Educator

What is your major and career Interests?

Describe your experience and knowledge about health education and any health areas such as: fitness, nutrition, stress management, eating disorders, weight control, sexuality, substance abuse, program planning, wellness and public health.

Where do you obtain most of your information about health?

List any courses which you have completed in health, education, counseling, group work, nutrition, fitness, stress management, sexuality, substance abuse, poverty, environmental health, health care, minority health or public/health policy.

Describe any experience you may have in counseling, working one on one, teaching and small group leadership. What skills do you bring to the program?

Please include contact information from a previous or current instructor, employer/supervisor, and co-worker/ fellow student. Contact information must be completed with application.

Current Instructor:
Class title:
Phone#:
E-Mail:

Employer/Supervisor Name:
Type of Employment:
Phone#:
E-Mail:

Co-Worker/Fellow Student:
Phone#:
E-Mail:

Where did you find out about Peer Health Education?

Health Center
Career Center
Health Ed.Program
Peer Health Educator
Another Department

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