Horizons Peer Educators

Students Helping Students

Horizons Peer Educators Application

(please print legibly)

 

Date______________

 

Name________________________________  Student Number____________________

 

Address_________________________________________________________________

 

________________________________________________________________________

 

Home Phone(       )______________  Alternate Phone(       )______________ type_____

 

E-mail Address__________________@________________________

 

Present Class Status at UMSL        Freshman      Sophomore     Junior     Senior     Grad

 

Current Cumulative G.P.A.  __________

 

Semester you began at UMSL ___________     Expected Date of Graduation___________

 

Major___________________________          Minor_________________________

 

Did you transfer from another college?  YES  NO  From where?___________________

 

Degrees earned there___________________

 

How many credit hours are you currently taking?_____________

 

How many credit hours do you plan on taking next semester?_____________

 

Are you carrying any delayed grades?  YES  NO  How many?_______________

 

Will you be working anywhere else?  YES  NO  Where?_______________________

 

How many hours will you be working at this other job?_________________

 

How many hours per week would you like to work for Horizons?__________________

 

How did you hear about Horizons?

 

________________________________________________________________________

 

PLEASE ANSWER THE FOLLOWING ON A SEPRATE SHEET OF PAPER AND TURN IN WITH YOUR APPLICATION…….

 

· Why are you interested in becoming a Peer Educator?

 

· What other organizations or extracurricular activities do you currently participate in?

 

· What extracurricular activities were you active in during high school?

 

· What else do you want to tell us about yourself?