HealthBuffs Peer Education Application Thank you for your interest in becoming a HealthBuff Peer Educator. Each question should be answered thoroughly and accurately. You must have JavaScript enabled to use this form. Indicates required field Name Street Address Apartment/Unit Number City State Å·ÃÀ¿Ú±¬ÊÓƵ Email Address Are you an undergraduate student? Yes No Do you have a work-study award? Yes No Education Major, Projected Graduation Date, College Please check area(s) of expertise/experience: Event planning Peer education Customer Service Outreach and engagement Presentation and facilitation skills Other Are you currently working for another Å·ÃÀ¿Ú±¬ÊÓƵ employer? Yes No If yes, please list department name and name of supervisor: What interests you about working with Health Promotion? What do you hope to learn through working with the program? What do you think are the top three factors that impact health and wellness among your peers? Why? What strengths would you bring to the position? I am a degree-seeking Å·ÃÀ¿Ú±¬ÊÓƵ Boulder student and am planning to be enrolled in a least six credit hours per semester throughout the duration of my employment. Yes No I verify that I have a current GPA of at least 2.5. Yes No I am able to participate in required Monday staff meetings, usually 5–6 p.m. during the academic year. Yes No I am available for the mandatory training in August prior to semester start. Yes No I am available to work some evenings and weekends. Yes No I understand that a background check may be required as a condition of employment. Yes No I understand that I will not receive medical or clinical experience as part of my involvement with HealthBuffs. Yes No Peer educator positions with the HealthBuffs program are limited and highly selective. If you don’t receive an offer for a paid position, would you be interested in a volunteer or intern position? Yes No Please attach a resume, including your work history. One file only.2 MB limit.Allowed types: pdf, doc, docx. Please list two professional references, including contact information and their relationship to you. How would you describe your gender identity? (optional) Woman Man Non-binary Choose not to answer Other Do you identify as trans? (optional) Yes No Choose not to answer How would you describe your racial identity? (choose one or more, optional) American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Asian White Black or African American Other Choose not to answer Are you Hispanic or Latino/a/x? (optional) Yes No Choose not to answer How did you hear about HealthBuffs? (optional) Saw a flyer around campus Received an email Recommended by a friend Classroom presentation HealthBuffs outreach event Other
