Peer Health Education Internship Application Form


The Peer Health Education program is designed to facilitate the development and maintenance of healthy lifestyles in University of Oregon students. To meet this goal, a variety of services are available including: group presentations, lending library in the Peer Health Promotion Office in the Health Center and Wellness Wednesday publications in the Emerald. The Peer Health Education program is a core component of the Health Promotion Department. The Peer Health Education program requires a two term commitment (FHS 407 4 credit hrs/term). The program includes classes designed to develop knowledge of current health issues, public health issues, behavior change principles, as well as presentation skills. The class meets every Tuesday and Thursday 10:00-11:50. Must be at least a sophomore to apply.

Application Procedure:
Interested students should complete and submit the following application form (with reference contact information). An interview is necessary for entrance into the program. The prerequisites are enthusiasm, ability to work in groups, accept supervisory feedback, interest in public health policy for disease prevention and health promotion as well as a strong interest in working with your peers for the enhancement of healthy lifestyle choices.

First Name: Last Name:

Email: Local Phone #:

Cell #: Student ID #:

Best time to reach you:
Morning
Afternoon
Evening 		Year in School:  
Sophomore
Junior
Senior 		Term you wish to enter program: 
Fall
Winter
Spring

Please explain briefly why you want to be a Peer Health Educator.

What is your major and career Interests?

Describe your experience and knowledge about health education and any health areas such as: fitness, nutrition, stress management, eating disorders, weight control, sexuality, substance abuse, program planning, wellness and public health.

Where do you obtain most of your information about health?

List any courses which you have completed in health, education, counseling, group work, nutrition, fitness, stress management, sexuality, substance abuse, poverty, environmental health, health care, minority health or public/health policy.

Describe any experience you may have in counseling, working one on one, teaching and small group leadership. What skills do you bring to the program?

Please include contact information from a previous or current instructor, employer/supervisor, and co-worker/ fellow student. Contact information must be completed with application.

Current Instructor:
Class Title:
Phone#:
E-Mail:

Employer/Supervisor Name:
Type of Employment:
Phone#:
E-Mail:

Co-Worker/Fellow Student:
Phone#:
E-Mail:

How did you find out about Peer Health Education? Select all that apply.

Health Center
Health Ed Workshop
Other Health Ed.Programs
Peer Health Educator
Another Department

Wellness Wednesday Article
Emerald Ad
Internet
Friend

Classroom Announcementt
Facebook
Health Center Resource Packet
Other

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Latest Revision 10/7/2008