HealthBuffs Peer Wellness Coach 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 as peer wellness coach? What do you hope to gain? *

Describe a time you set a personal wellness goal for yourself. Please explain your process in setting and working toward this goal. *

What strengths would you bring as peer wellness coach? *

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 commit to being a peer wellness coach for at least one academic year. *

Yes

No

I understand that a background check may be required as a condition of employment. *

Yes

No

I have reviewed the peer wellness coach job description and am able to meet the work expectations. *

Yes

No

Peer wellness coach positions with the HealthBuffs program are limited and highly selective. If you don’t receive an offer for a peer wellness coach position, would you be interested in a peer educator 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 Peer Wellness Coaching? (optional)

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HealthBuffs Peer Wellness Coach Application