PEERS STUDENT APPLICATION FORM
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
School Name:
GPA
Graduation Date
T-Shirt Size
Parent/Guardian Information
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Information (2) (Optional)
First Name
Last Name
Phone Number
Please enter a valid phone number.
Research studies have found IT IS ESSENTIAL that PEERS mentors "Live up to" the same standard they teach. To convince others to make positive choices regarding their behavior, mentors prove, through their own life experience, that it is possible to overcome this pressure. With this in mind, please write your answers to the following questions:
Why do you think you are qualified to be a PEERS mentor?
*
Why have you decided to overcome the pressure of drugs, sex, and alcohol?
*
Who, or What, in your life has encouraged or strengthened your decision to make healthy choices?
*
How are you a positive influence on others?
*
As a PEERS mentor, you will be required to present in front of a small group of peers. Will you be able to do this?
*
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