HealthBuffs Peer Education Application

Name *

Street Address *

Apartment/Unit Number

City *

State *

Zip Code *

Phone Number *

CU Email Address *

Student ID Number *

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: *

Are you currently working for another CU 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 CU 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 list two professional references, including contact information and their relationship to you. *

How would you describe your gender identity? (optional)

Do you identify as trans? (optional)

Yes

No

Choose not to answer

How would you describe your racial identity? (choose one or more, optional)

Are you Hispanic or Latino/a/x? (optional)

Yes

No

Choose not to answer

How did you hear about HealthBuffs? (optional)

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HealthBuffs Peer Education Application