Peer Advocate Application

TSI Peer Advocate Application
Thank you for your interest in serving as a Peer Advocate for the TSU SHAPE Initiative (TSI) Program. Please complete and submit this document for TSI to review. You will receive a copy of your completed application and we will follow-up with you within 48 business hours.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Age*

1819202122232425+
Gender*

FemaleMaleTransgenderOtherPrefer not to disclose
Ethnicity*

Black/African AmericanHispanic/LatinxAmerican Indian/Alaska NativeAsian/Pacific IslanderPacific IslanderMulti-racialWhiteOther
Do you currently, worship, work or attend college in the Greater 3rd and/or 5th Ward communities?*

Yes-3rd & 5th WardsYes-5th Ward OnlyYes-3rd Ward OnlyNo-Neither 3rd or 5th Ward
Are you currently enrolled at a college or university?*

Yes (List Institution) ________________________________No
What is the highest completed level of education?*

High SchoolAssociates DegreeBachelor's DegreeMaster's DegreePhD DegreeDid not graduate high school
Do you speak any language other than English?*

Yes (List Language(s)) _______________________No
Describe reason(s) that motivate you to become a Peer Advocate for TSU SHAPE Initiative:*
What qualities do you possess that would make you a good Peer Advocate?*
Should be Empty:

TSI Peer Advocate Application